Provider Demographics
NPI:1467691188
Name:MOODY, JOBETH LANELL
Entity Type:Individual
Prefix:
First Name:JOBETH
Middle Name:LANELL
Last Name:MOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOBETH
Other - Middle Name:LANELL
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:245 EXECUTIVE AVE
Mailing Address - Street 2:1C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1389
Mailing Address - Country:US
Mailing Address - Phone:931-802-8872
Mailing Address - Fax:
Practice Address - Street 1:245 EXECUTIVE AVE
Practice Address - Street 2:1C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1389
Practice Address - Country:US
Practice Address - Phone:931-802-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other