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General NPI Number Information
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NPI Number | 1902042799
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Entity Type | Individual
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Provider Name | CHARLSIE FAITH MOORE RN
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Gender | Female
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Dates
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Enumeration Date | 12/28/2008
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Last Update Date | 12/28/2008
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Provider Practice Location Address
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Address Line | 1545 BETHLEHEM CHURCH RD
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City | GRANTVILLE
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State | GA
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Zip | 30220-1835
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Country | US
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Telephone | 770-820-5438
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 BETHLEHEM CHURCH RD
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City | GRANTVILLE
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State | GA
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Zip | 30220-1835
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Country | US
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Telephone | 770-820-5438
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN168618
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001200802
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200020
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License Number State | NC
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