Provider Demographics
NPI:1710934633
Name:MOODY, FELICE PEARL (MD)
Entity Type:Individual
Prefix:
First Name:FELICE
Middle Name:PEARL
Last Name:MOODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:STE 2300
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-224-1232
Mailing Address - Fax:864-224-1273
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:STE 2300
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-224-1232
Practice Address - Fax:864-224-1273
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01676Medicaid
SCP01034600OtherRR MEDICARE
SC7111Medicare PIN
SCG38709Medicare UPIN