Healthcare Provider Details

I. General information

NPI: 1861607194
Provider Name (Legal Business Name): VICKIE S MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 EAST PARKWAY SUITE #7
GATLINBURG TN
37738-4915
US

IV. Provider business mailing address

815 EAST PARKWAY SUITE #7
GATLINBURG TN
37738-4915
US

V. Phone/Fax

Practice location:
  • Phone: 865-436-2811
  • Fax: 865-436-2812
Mailing address:
  • Phone: 865-436-2811
  • Fax: 865-436-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000014031
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: