Healthcare Provider Details

I. General information

NPI: 1932806684
Provider Name (Legal Business Name): MRS. SIERRA BETH MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PIRKLE FERRY RD
CUMMING GA
30040-2544
US

IV. Provider business mailing address

108 FEATHERSTONE DR
WARNER ROBINS GA
31088-5697
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number001580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: