Healthcare Provider Details

I. General information

NPI: 1497664007
Provider Name (Legal Business Name): TIARA MOORE-JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8531 JENSON DR
JONESBORO GA
30236-3733
US

IV. Provider business mailing address

8531 JENSON DR
JONESBORO GA
30236-3733
US

V. Phone/Fax

Practice location:
  • Phone: 470-209-8120
  • Fax:
Mailing address:
  • Phone: 470-209-8120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-509659
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: