MEDICARE: DR. BRIAN LEE MOORE PH.D.

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	103T00000X	Psychologist	PSY001097	GA
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY001097	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538382908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN LEE MOORE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 3152
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30061-3152
Country	:	US
Telephone Number	:	770-590-4441
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 GALLERIA PKWY SE
Second Line	:	SUITE 1500
City	:	ATLANTA
State	:	GA
Zip	:	30339-5980
Country	:	US
Telephone Number	:	770-590-4441
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	09/11/2025

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