Organization
CHARLES B MOOMEY JR MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BRUCE MOOMEY JR. M.D. (OWNER)
(770) 962-9977
Entity
Organization
Contact information
Practice address
631 PROFESSIONAL DRIVE, SUITE 300, LAWRENCEVILLE, GA 30046-3371
(770) 962-9977
(770) 339-9804
Mailing address
631 PROFESSIONAL DRIVE, SUITE 300, LAWRENCEVILLE, GA 30046-3371
(770) 962-9977
(770) 339-9804
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
049923
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00899951A
—
GA
Enumeration date
07/02/2007
Last updated
09/01/2010
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