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General NPI Number Information
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NPI Number | 1528840428
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Entity Type | Individual
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Provider Name | LATECKA S MOORE
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 147 E MONTGOMERY XRD
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City | SAVANNAH
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State | GA
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Zip | 31406-4730
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Country | US
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Telephone | 912-201-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 147 E MONTGOMERY XRD
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City | SAVANNAH
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State | GA
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Zip | 31406-4730
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Country | US
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Telephone | 912-201-1701
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CO133923
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CO133923
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | CO133923
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CO133923
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License Number State | GA
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