Provider Demographics
NPI:1336205764
Name:HOWARD, DUDLEY MOYE (DC)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:MOYE
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TEBEAU ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6359
Mailing Address - Country:US
Mailing Address - Phone:912-283-4300
Mailing Address - Fax:912-283-3938
Practice Address - Street 1:2000 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6359
Practice Address - Country:US
Practice Address - Phone:912-283-4300
Practice Address - Fax:912-283-3938
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGRCMedicare UPIN
GAGRP4344Medicare ID - Type UnspecifiedMED GROUP #