MEDICARE: MARY EVELYN MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4585C	AL

General Provider Information

NPI Number	:	1194497974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY EVELYN MOORE

Provider Business Mailing Address
First Line	:	48 MEDICAL PARK DR E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3400
Country	:	US
Telephone Number	:	205-338-3349
Fax Number	:	205-838-3451

Provider Business Practice Location Address
First Line	:	48 MEDICAL PARK DR E STE 159
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3462
Country	:	US
Telephone Number	:	205-338-3349
Fax Number	:	205-838-3451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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Directions to “ MARY EVELYN MOORE ” Practice Location

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