NPIMap

Individual provider Active NPI

Michael Shannon Moody, MD

  • Family Medicine Physician
  • Douglasville, GA
National Provider Identifier
1952466583
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
037626 Issued in GA
Practice address
8464 Adair Sreet
Douglasville, GA 30134-1877
Phone
(770) 949-9804
Fax
(770) 949-9842
NPI assigned
Dec 26, 2006
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 037626 GA Primary

Addresses

Primary practice location

8464 Adair Sreet
Douglasville, GA 30134-1877

Mailing address

8464 Adair St
Douglasville, GA 30134-1839
Phone (770) 949-9804

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111111000090 GA Practitioner - Family Practice 5597939439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Georgia School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Total Care Family Medicine PCGroup PAC ID 2668413360, 4 clinicians

Practice addresses (Care Compare)

8464 Adair St
Suite a
Douglasville, GA 30134-1836
Phone (770) 949-9804

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Total Care Family Medicine PC Family Medicine CurrentSince Jun 10, 2024 Accepting new patients
Life Care Family Practice Family Medicine CurrentSince Nov 9, 1998 Accepting new patients
Family Hospice and Palliative Care LLC CurrentSince Apr 1, 2024 Accepting new patients
Angel Heart Hospice, LLC Family Medicine Past Accepting new patients

Locations

1039 E Freeway Dr SE
Conyers, GA 30094
Phone (770) 922-0076

8464 Adair St
Douglasville, GA 30134
Phone (770) 949-0507

8464 Adair St
Ste A
Douglasville, GA 30134
Phone (770) 949-9804

435 W Bankhead Hwy
Villa Rica, GA 30180

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family HospiceVilla Rica, GA, CCN 111764 Hospice Contracted Managing Employee Dec 8, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1952466583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8464 ADAIR ST",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341839",
            "telephone_number": "770-949-9804",
            "fax_number": "770-949-9842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8464 ADAIR SREET",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341877",
            "telephone_number": "770-949-9804",
            "fax_number": "770-949-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "MICHAEL",
        "middle_name": "SHANNON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "037626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

Verify at the official NPI Registry.