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NPI Code Detail

MEDICARE: DR. SANDRA E MOORE MD

MEDICARE: DR. SANDRA E 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
1208000000XPediatrics Physician051517GA

General Provider Information

NPI Number : 1467452375
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA E MOORE MD
Provider Business Mailing Address
First Line : 777 HEMLOCK ST
Second Line : MSC 83
City : MACON
State : GA
Zip : 31201-2102
Country : US
Telephone Number : 478-633-7140
Fax Number :
Provider Business Practice Location Address
First Line : 777 HEMLOCK ST
Second Line : MSC 83
City : MACON
State : GA
Zip : 31201-2102
Country : US
Telephone Number : 478-633-7140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/21/2022

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Directions to “ DR. SANDRA E MOORE MD” Practice Location

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