Provider Demographics
NPI:1457325862
Name:MOODY, RICHARD DL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DL
Last Name:MOODY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:961 SPRING CREEK RD
Mailing Address - Street 2:CHATTANOOGA FAMILY PRACTICE ASSOCIATES PC
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3909
Mailing Address - Country:US
Mailing Address - Phone:423-892-2221
Mailing Address - Fax:423-490-3407
Practice Address - Street 1:961 SPRING CREEK RD
Practice Address - Street 2:CHATTANOOGA FAMILY PRACTICE ASSOCIATES PC
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-892-2221
Practice Address - Fax:423-490-3407
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-03-05
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Provider Licenses
StateLicense IDTaxonomies
TN36195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3871964Medicaid
TN3871964Medicaid
G78563Medicare UPIN