Healthcare Provider Details

I. General information

NPI: 1568438547
Provider Name (Legal Business Name): EARNEST DARREN MOORE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 302
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

7288 SNAPDRAGON LN
OOLTEWAH TN
37363-6579
US

V. Phone/Fax

Practice location:
  • Phone: 888-408-0200
  • Fax: 888-505-6721
Mailing address:
  • Phone: 423-304-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN136019
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN11360
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN108827
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: