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General NPI Number Information
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NPI Number | 1922810498
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Entity Type | Individual
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Provider Name | DEMETRIUS MOORE ND
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 612 W CROSSVILLE RD STE 200
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City | ROSWELL
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State | GA
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Zip | 30075-2539
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Country | US
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Telephone | 470-749-6107
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Fax |
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Provider Business Mailing Address
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Address Line | 1398 KEYHAVEN CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2797
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Country | US
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Telephone | 470-749-6107
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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