Provider Demographics
NPI:1356559801
Name:MOODY, RAYMOND AVERY III (DO)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:AVERY
Last Name:MOODY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:504 GORNTO RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1602
Mailing Address - Country:US
Mailing Address - Phone:229-253-1267
Mailing Address - Fax:
Practice Address - Street 1:348 ENTERPRISE DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5697
Practice Address - Country:US
Practice Address - Phone:229-293-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51990207Q00000X
GA051990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine