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General NPI Number Information
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NPI Number | 1780070730
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Entity Type | Organization
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Legal Business Name | J. MOORE M.D. LLC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 2860 MAIN ST W STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-3156
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Country | US
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Telephone | 770-809-1199
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Fax | 770-266-0941
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Provider Business Mailing Address
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Address Line | 1350 BULLOCK PL SW
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City | LILBURN
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State | GA
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Zip | 30047-1989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOCELYN MOORE
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Credential | MD
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Telephone | 202-494-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 67368
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License Number State | GA
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