Winfred Derrick Moody, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

045299 Issued in GA

Practice address

565 Old Norcross Rd
Suite #200
Lawrenceville, GA 30046-4308

Phone

(770) 962-5040

Fax

(770) 962-5056

NPI assigned

Nov 16, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Medical College of Georgia School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Dermatology PC

  • Dermatology Physician
  • Lawrenceville, GA
  • NPI 1437437837
  Medicare reassignment Authorized official
• Advanced Dermatology of Georgia, LLC

  • Dermatology Physician
  • Albany, GA
  • NPI 1184005068
  NPD (past)
• Wesley S Wilborn MD PC

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1750554978
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1124000187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2295 CAPE COURAGE WAY",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242760",
            "telephone_number": "678-371-8167",
            "fax_number": "678-376-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 OLD NORCROSS RD",
            "address_2": "SUITE #200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464308",
            "telephone_number": "770-962-5040",
            "fax_number": "770-962-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "WINFRED",
        "middle_name": "DERRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "GA",
            "license": "045299",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "045299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000821158A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latoya Venise Montfort, ACAGNP
• David James Montgomery Jr.
• Dea Rabon Montgomery, PH.D.
• Sydney Nicole Montgomery
• Andrea Moody, LCSW
• Ann Marie Moon
• Michelle Moon
• Daneille Mooney, MSN, CNM
• Hadiya Torkwase Moore-Stigler
• Cynthia Moore, AGNP-BC

• Dermatology Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.