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NPI Code Detail

MEDICARE: DR. MARIAH MICHELLE MOORE MD

MEDICARE: DR. MARIAH MICHELLE MOORE MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1144162413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIAH MICHELLE MOORE MD
Provider Business Mailing Address
First Line : 1301 PRIMACY PKWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-0213
Country : US
Telephone Number : 901-448-0276
Fax Number :
Provider Business Practice Location Address
First Line : 1301 PRIMACY PKWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-0213
Country : US
Telephone Number : 901-448-0276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ DR. MARIAH MICHELLE MOORE MD” Practice Location

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