| Moonlight Diagnostics Llc | |
|
3188 Parliament Cir Ste 802 Montgomery AL 36116-7271 | |
| (334) 416-8298 | |
| (833) 260-4473 |
| Full Name | Moonlight Diagnostics Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3188 Parliament Cir Ste 802, Montgomery, Alabama |
| Authorized Official Name and Position | Gregory R Lipscomb (PRESIDENT) |
| Authorized Official Contact | 2515547798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonlight Diagnostics Llc 3188 Parliament Cir Ste 802 Montgomery AL 36116-7271 Ph: (334) 416-8298 | Moonlight Diagnostics Llc 3188 Parliament Cir Ste 802 Montgomery AL 36116-7271 Ph: (334) 416-8298 |
| NPI Number | 1801351291 |
|---|---|
| Provider Enumeration Date | 02/10/2019 |
| Last Update Date | 06/03/2019 |
| Medicare PECOS PAC ID | 9335480730 |
|---|---|
| Medicare Enrollment ID | O20190412000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801351291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Gregory R Lipscomb |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427218114 PECOS PAC ID: 4587846423 Enrollment ID: I20110314000517 |
| Provider Name | Amanda D Hargrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568895589 PECOS PAC ID: 6608094537 Enrollment ID: I20140905001406 |
| Provider Name | Caroline Brawley Johnson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1811688419 PECOS PAC ID: 4880050343 Enrollment ID: I20230525002533 |
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