Individual provider Active NPI

Takatso Moyo

  • Family Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1952809774
Registry record updated Jan 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F05170157 Issued in GA
Practice address
475 Philip Blvd Ste 100
Lawrenceville, GA 30046-8736
Phone
(770) 995-3300
Fax
(770) 995-0794
NPI assigned
Jan 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F05170157 GA Primary

Addresses

Primary practice location

475 Philip Blvd Ste 100
Lawrenceville, GA 30046-8736

Mailing address

475 Philip Blvd Ste 100
Lawrenceville, GA 30046-8736
Phone (770) 995-3300

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180724004142 GA Practitioner - Nurse Practitioner 2769739507 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.64 of 100Reported as group
Quality
76.13
Improvement activities
40
Cost
69.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F05170157GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Mso LLC CurrentSince Apr 15, 2025 Accepting new patients
Hardy Renew Wellness,LLC CurrentSince Nov 26, 2024 Accepting new patients
Infinite Medical PC CurrentSince May 4, 2021 Accepting new patients
Medical Director Services PC CurrentSince Aug 1, 2020 Accepting new patients

Locations

2850 Springdale Rd SW
Atlanta, GA 30315
Phone (404) 616-8100

22 Maple Ridge Dr
Cartersville, GA 30121
Phone (770) 606-8800

1640 Powers Ferry Rd SE
Bldg 15
Marietta, GA 30067
Phone (770) 722-9595

250 Skillman St
Ste 202
Brooklyn, NY 11205

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": "1516924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516924800000",
    "number": "1952809774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468736",
            "telephone_number": "770-995-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468736",
            "telephone_number": "770-995-3300",
            "fax_number": "770-995-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYO",
        "first_name": "TAKATSO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-26",
        "last_updated": "2018-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F05170157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.