Provider Demographics
NPI:1588020135
Name:MOODY, FONDA (FON TRANS)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:FON TRANS
Other - Prefix:
Other - First Name:FONDA
Other - Middle Name:
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FON TRANS
Mailing Address - Street 1:50 HARBOR OAKS CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-6069
Mailing Address - Country:US
Mailing Address - Phone:901-355-4258
Mailing Address - Fax:
Practice Address - Street 1:50 HARBOR OAKS CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-6069
Practice Address - Country:US
Practice Address - Phone:901-355-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171000000XOther Service ProvidersMilitary Health Care Provider
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle