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General NPI Number Information
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NPI Number | 1437875879
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Entity Type | Individual
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Provider Name | ROSLYN MOORE
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Gender | Female
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 185 OLD PEACHTREE RD NW
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City | SUWANEE
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State | GA
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Zip | 30024-2511
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Country | US
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Telephone | 678-937-0300
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Fax | 781-464-2599
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Provider Business Mailing Address
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Address Line | 185 OLD PEACHTREE RD NW
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City | SUWANEE
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State | GA
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Zip | 30024-2511
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Country | US
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Telephone | 678-937-0300
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Fax | 781-464-2599
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP105131
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN105131
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License Number State | GA
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