Healthcare Provider Details

I. General information

NPI: 1427513266
Provider Name (Legal Business Name): CYNTHIA ANN MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 PRIOR ST SE
GAINESVILLE GA
30501-3402
US

IV. Provider business mailing address

2830 HAVEN LN
DECATUR GA
30030-5514
US

V. Phone/Fax

Practice location:
  • Phone: 770-538-2788
  • Fax:
Mailing address:
  • Phone: 404-218-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number34905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: