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General NPI Number Information
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NPI Number | 1497767792
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Entity Type | Individual
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Provider Name | J DAVID MOORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 01/31/2021
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Provider Practice Location Address
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Address Line | 23 BUENA VISTA WAY, STE B
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City | GREENVILLE
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State | SC
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Zip | 29615
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Country | US
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Telephone | 864-315-3736
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Fax | 864-315-3736
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Provider Business Mailing Address
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Address Line | 1491 ALTAMONT RD
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City | GREENVILLE
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State | SC
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Zip | 29609-6211
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Country | US
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Telephone | 864-546-8284
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Fax | 864-315-3736
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 040166
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35169
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License Number State | SC
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