Provider Demographics
NPI:1629191853
Name:MOODY, RYAN BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BRETT
Last Name:MOODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HODGSON CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1520
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:BLDG. #5
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-6270
Practice Address - Fax:912-927-6254
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59284207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00619290OtherRAILROAD MEDICARE
GA696088793AMedicaid
GA11SCHRFMedicare PIN
GAG59284Medicare UPIN