Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 0101255670 | VA |
NPI | 1053755306 |
---|---|
Provider Name | Dr. Aaron Lee Moody |
First Address | Beaufort, SC 29902-6122 |
Second Address | Beaufort, SC 29902-6122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 10/08/2021 |