Healthcare Provider Details

I. General information

NPI: 1871571869
Provider Name (Legal Business Name): JENNIFER LAWSON MOORE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE # 1185
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 404-223-0792
  • Fax: 404-223-5815
Mailing address:
  • Phone: 770-496-9400
  • Fax: 770-496-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN144756
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: