Individual
MRS. SOPHIA GRACE MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6331 CARMEL RD STE 102, CHARLOTTE, NC 28226-8286
(704) 316-2557
Mailing address
8840 BRANDON CIR, CONCORD, NC 28025-8112
(954) 254-4046
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5017823
NC
363LP0200X
Pediatric Nurse Practitioner
5017823
NC
Other
Enumeration date
03/14/2023
Last updated
07/25/2024
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