Provider Demographics
NPI:1508588948
Name:MOOTY, TERRY LEE (CAA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:MOOTY
Suffix:
Gender:M
Credentials:CAA
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Mailing Address - Street 1:208 FALLIGANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1414
Mailing Address - Country:US
Mailing Address - Phone:319-239-2743
Mailing Address - Fax:
Practice Address - Street 1:11705 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1711
Practice Address - Country:US
Practice Address - Phone:912-819-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
367H00000X
GA11210367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant