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General NPI Number Information
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NPI Number | 1114485828
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Entity Type | Individual
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Provider Name | JOYCE MARIE MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BOULEVARD MARTIN ARMY COMMUNITY HOSPITAL
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 912-977-9792
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Fax |
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Provider Business Mailing Address
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Address Line | 379 RIVERSIDE DR
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City | JESUP
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State | GA
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Zip | 31545-5337
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Country | US
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Telephone | 912-977-9792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW006382
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License Number State | GA
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