MEDICARE: KAYDE 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	363A00000X	Physician Assistant	7468	GA

General Provider Information

NPI Number	:	1891184453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYDE MOORE

Provider Business Mailing Address
First Line	:	PO BOX 749495
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9495
Country	:	US
Telephone Number	:	239-432-8331
Fax Number	:	813-321-1296

Provider Business Practice Location Address
First Line	:	1111 GLYNCO PKWY STE 35
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-7930
Country	:	US
Telephone Number	:	912-304-7013
Fax Number	:	912-342-1025

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	12/29/2022

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Directions to “ KAYDE MOORE ” Practice Location

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