Individual
MICHAEL SHANNON MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8464 ADAIR SREET, DOUGLASVILLE, GA 30134-1877
(770) 949-9804
(770) 949-9842
Mailing address
8464 ADAIR ST, DOUGLASVILLE, GA 30134-1839
(770) 949-9804
(770) 949-9842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
037626
GA
Other
Enumeration date
12/26/2006
Last updated
08/31/2023
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