Provider Demographics
NPI:1235422429
Name:MOONEYHAM, GENALYNNE CARWILE (MD)
Entity Type:Individual
Prefix:
First Name:GENALYNNE
Middle Name:CARWILE
Last Name:MOONEYHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENALYNNE
Other - Middle Name:
Other - Last Name:CARWILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 63362
Mailing Address - Street 2:#201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:919-620-4918
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:1111 W 10TH ST
Practice Address - Street 2:#201
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4800
Practice Address - Country:US
Practice Address - Phone:317-274-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206-008152084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry