| Doctor Name: | DR. ANDREW MOULTRIE |
| NPI Number: | 1376746545 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 50977 |
| Business Practice Address: | 2047 Central Ave Augusta, GA - 309044178 |
| Business Phone Number: | 7067387557 |
| Business Fax Number: | |
| Mailing Address: | 6356 Boyett Dr, NORCROSS |
| State: | GA |
| Postal Code: | 300933507 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 50977 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |