Provider Demographics
NPI:1134389562
Name:MOODY, TONJA FREEMAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:TONJA
Middle Name:FREEMAN
Last Name:MOODY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST., NE
Mailing Address - Street 2:SUITE 1750
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-881-8319
Mailing Address - Fax:404-523-6791
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-881-8319
Practice Address - Fax:404-523-6791
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I970429Medicare PIN