Healthcare Provider Details

I. General information

NPI: 1346896784
Provider Name (Legal Business Name): JAMIA MOORE DNP, APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MARKET ST
ATHENS AL
35611-2457
US

IV. Provider business mailing address

702 GALAXY DR
JACKSON TN
38305-6663
US

V. Phone/Fax

Practice location:
  • Phone: 256-658-4284
  • Fax:
Mailing address:
  • Phone: 256-658-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-136621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: