Provider Demographics
NPI:1568085330
Name:MORELAND, MONYA (CCMA)
Entity Type:Individual
Prefix:
First Name:MONYA
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 TREE TERRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5544
Mailing Address - Country:US
Mailing Address - Phone:850-512-5725
Mailing Address - Fax:
Practice Address - Street 1:1008 TREE TERRACE PKWY
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5544
Practice Address - Country:US
Practice Address - Phone:850-512-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy