Provider Demographics
NPI:1255306908
Name:MOFFET, JOHN BOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BOYD
Last Name:MOFFET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 COLLEGE AVE S
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2302
Mailing Address - Country:US
Mailing Address - Phone:912-384-5678
Mailing Address - Fax:
Practice Address - Street 1:216 COLLEGE AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2302
Practice Address - Country:US
Practice Address - Phone:912-384-5678
Practice Address - Fax:912-384-5510
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000277197CMedicaid
GAT97744Medicare UPIN