Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LDO001395 | GA |
NPI | 1053832402 |
---|---|
Provider Name | Ms. Deborah Woods Moody |
First Address | Lithonia, GA 30058-4412 |
Second Address | Lithonia, GA 30058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |