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General NPI Number Information
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NPI Number | 1497728406
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Entity Type | Individual
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Provider Name | VICKI LYNN MOORE CST/CFA
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1409 DUNWOODY PLACE
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City | ATLANTA
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State | GA
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Zip | 30350
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Country | US
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Telephone | 770-594-1351
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Fax | 770-594-1381
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Provider Business Mailing Address
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Address Line | 80 MOORE RD
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City | KINGSTON
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State | GA
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Zip | 30145-2619
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Country | US
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Telephone | 770-842-1857
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Fax | 770-606-0129
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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