Healthcare Provider Details

I. General information

NPI: 1447858055
Provider Name (Legal Business Name): LAURAN N MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 ATKINSON DR
DALTON GA
30720-3902
US

IV. Provider business mailing address

808 ATKINSON DR
DALTON GA
30720-3902
US

V. Phone/Fax

Practice location:
  • Phone: 423-310-2045
  • Fax:
Mailing address:
  • Phone: 423-310-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68397
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: