MEDICARE: CATARA MOORE CDMS

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	171M00000X	Case Manager/Care Coordinator	4256093	GA

General Provider Information

NPI Number	:	1437884269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATARA MOORE CDMS

Provider Business Mailing Address
First Line	:	3227 FLOWERS RD S APT A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5681
Country	:	US
Telephone Number	:	334-303-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3227 FLOWERS RD S APT A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5681
Country	:	US
Telephone Number	:	334-303-1901
Fax Number	:

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

Provider Enumeration Date	:	07/16/2022
Last Update Date	:	07/16/2022

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