Healthcare Provider Details

I. General information

NPI: 1336836626
Provider Name (Legal Business Name): SYDNEY MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PERIMETER CENTER PKWY NE STE 200
ATLANTA GA
30346-1305
US

IV. Provider business mailing address

2020 PENDLETON PL
SUWANEE GA
30024-2766
US

V. Phone/Fax

Practice location:
  • Phone: 855-492-7642
  • Fax:
Mailing address:
  • Phone: 404-625-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN307106
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: