MEDICARE: TRENTON K MOORE MMSC, PA-C, MS, ATC

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	2255A2300X	Athletic Trainer	AL 3533	FL
2	363A00000X	Physician Assistant	10266	GA

General Provider Information

NPI Number	:	1497162994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENTON K MOORE MMSC, PA-C, MS, ATC

Provider Business Mailing Address
First Line	:	2306 WISTERIA DR STE 240
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3563
Country	:	US
Telephone Number	:	678-344-4944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 WISTERIA DR STE 240
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3563
Country	:	US
Telephone Number	:	678-344-4944
Fax Number	:

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	03/05/2026

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