Provider Demographics
NPI:1083438550
Name:FLOYD, NETTIE MOORE (APC)
Entity type:Individual
Prefix:
First Name:NETTIE
Middle Name:MOORE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WOOD DUCK RD
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-2801
Mailing Address - Country:US
Mailing Address - Phone:478-308-0151
Mailing Address - Fax:
Practice Address - Street 1:2525 MOODY RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6109
Practice Address - Country:US
Practice Address - Phone:478-202-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional