Provider Demographics
NPI:1912263799
Name:BUTLER, MOYA P (RN)
Entity Type:Individual
Prefix:
First Name:MOYA
Middle Name:P
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 SCENIC HWY N STE 103B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6141
Mailing Address - Country:US
Mailing Address - Phone:866-551-9700
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:866-551-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN300255163W00000X
GA593137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse