MEDICARE: JAY MOORE FITNESS LLC

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1700579836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY MOORE FITNESS LLC

Provider Business Mailing Address
First Line	:	3105 SPRING GROVE DR STE F3
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-4381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 SPRING GROVE DR STE F3
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-4381
Country	:	US
Telephone Number	:	706-842-8481
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMELIA NAOMI MOORE
Credential	:
Telephone Number	:	706-842-8481

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “JAY MOORE FITNESS LLC ” Practice Location

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