| Doctor Name: | WANDA G MOODY |
| NPI Number: | 1861408999 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | APN0000007264 |
| Business Practice Address: | 99 Doctors Dr Suite 700 Munford, TN - 380586305 |
| Business Phone Number: | 9018377200 |
| Business Fax Number: | 9018374769 |
| Mailing Address: | 99 Doctors Dr, Suite 700 MUNFORD |
| State: | TN |
| Postal Code: | 380586305 |
| Phone Number: | 9018377200 |
| Fax Number: | 9018374769 |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN0000007264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |