Individual provider Active NPI

Robert Benjamin Moody III, RPH.

  • Pharmacist
  • Macon, GA
National Provider Identifier
1366464604
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH017629 Issued in GA
Practice address
380 Hospital Dr Ste 175-a
Macon, GA 31217-8001
Phone
(478) 745-5431
Fax
(478) 765-4359
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH017629 GA Primary

Addresses

Primary practice location

380 Hospital Dr Ste 175-a
Macon, GA 31217-8001

Mailing address

644 Millrun CT
Macon, GA 31210-7538
Phone (478) 471-8686

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
RPH017629GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Moodycare Inc Current Accepting new patients
Middle Moodycare Inc Current Accepting new patients
Southern Moodycare Inc Current Accepting new patients
Moodycare Inc. Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1366464604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 MILLRUN CT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312107538",
            "telephone_number": "478-471-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 HOSPITAL DR STE 175-A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178001",
            "telephone_number": "478-745-5431",
            "fax_number": "478-765-4359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "ROBERT",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "RPH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH017629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.