Healthcare Provider Details

I. General information

NPI: 1245326859
Provider Name (Legal Business Name): KAREN A MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN ROAD SE
MARIETTA GA
30067-8705
US

IV. Provider business mailing address

1405 FRANKLIN ROAD SE
MARIETTA GA
30067-8705
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 770-951-5408
Mailing address:
  • Phone: 770-951-5400
  • Fax: 770-951-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number029497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: