MEDICARE: VICKIE 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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1306464037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE MOORE

Provider Business Mailing Address
First Line	:	1639 BREEDS HILL LOOP
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7430
Country	:	US
Telephone Number	:	706-284-2075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 BREEDS HILL LOOP
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7430
Country	:	US
Telephone Number	:	706-284-2075
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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Directions to “ VICKIE MOORE ” Practice Location

Language	Start Address	Practice Location

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