MEDICARE: AMBER BROOKE MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1093226573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER BROOKE MOORE

Provider Business Mailing Address
First Line	:	2007 OLD LAFAYETTE RD
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-3510
Country	:	US
Telephone Number	:	706-861-9390
Fax Number	:	706-866-4740

Provider Business Practice Location Address
First Line	:	2007 OLD LAFAYETTE RD
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-3510
Country	:	US
Telephone Number	:	706-861-9390
Fax Number	:	706-866-4740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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