Moody, Winfred Derrick

Moody, Winfred Derrick is an individual health care provider with primary practice located at 565 Old Norcross Rd Suite #200, Lawrenceville GA 30046-4308. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Legal Medicine, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Moody, Winfred Derrick can be contacted via phone (770) 962-5040.

Contact Information

Primary practice address
565 Old Norcross Rd Suite #200 Lawrenceville GA 30046-4308
Phone: (770) 962-5040
Fax: (770) 962-5056
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Legal Medicine 173000000X 045299 Georgia
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 045299 Georgia

Profile Details

NPI number 1124000187
LBN Legal business name Moody, Winfred Derrick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2005
Last updated Feb 16th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124000187 NPPES
Georgia MEDICAID 000821158A

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