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General NPI Number Information
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NPI Number | 1962518316
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Entity Type | Individual
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Provider Name | HAROLD EARL MOORE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 2764 CANDLER RD
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City | DECATUR
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State | GA
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Zip | 30034-1410
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Country | US
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Telephone | 404-778-8600
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Fax | 404-778-8632
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Provider Business Mailing Address
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Address Line | 5461 HILLANDALE DRIVE SUITE 100
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City | LITHONIA
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State | GA
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Zip | 30058-4842
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Country | US
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Telephone | 404-778-8600
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Fax | 770-322-7983
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029216
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License Number State | GA
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