Individual
MARK MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
915 GORDON AVE, THOMASVILLE, GA 31792-6614
(334) 279-1450
(334) 395-4110
Mailing address
PO BOX 2125, COLUMBUS, GA 31902-2125
(334) 279-1450
(334) 395-4110
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
7370
GA
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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