Provider Demographics
NPI:1518714336
Name:MOODY, JASIA L
Entity type:Individual
Prefix:
First Name:JASIA
Middle Name:L
Last Name:MOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DOG FENNEL LN
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9444
Mailing Address - Country:US
Mailing Address - Phone:478-244-8608
Mailing Address - Fax:
Practice Address - Street 1:101 DOG FENNEL LN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9444
Practice Address - Country:US
Practice Address - Phone:478-244-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst