Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | GA 002533 | GA |
NPI | 1235343328 |
---|---|
Provider Name | Dr. Tim Scott Moeckel |
First Address | Lawrenceville, GA 30044-4212 |
Second Address | Lawrenceville, GA 30044-4212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |