MEDICARE: JAMES LEWIS MOORE MD

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	208200000X	Plastic Surgery Physician	021556	GA

General Provider Information

NPI Number	:	1538175641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEWIS MOORE MD

Provider Business Mailing Address
First Line	:	740 PRINCE AVE
Second Line	:	BLDG 10
City	:	ATHENS
State	:	GA
Zip	:	30606-5908
Country	:	US
Telephone Number	:	706-850-3603
Fax Number	:	706-850-8856

Provider Business Practice Location Address
First Line	:	740 PRINCE AVE
Second Line	:	BLDG 10
City	:	ATHENS
State	:	GA
Zip	:	30606-5908
Country	:	US
Telephone Number	:	706-850-3603
Fax Number	:	706-850-8856

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/23/2017

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