MEDICARE: STEPHANIE 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	163W00000X	Registered Nurse	RN224349	GA

General Provider Information

NPI Number	:	1730770264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MOORE

Provider Business Mailing Address
First Line	:	4867 ASHFORD DUNWOODY RD APT 6205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-4887
Country	:	US
Telephone Number	:	904-334-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	4867 ASHFORD DUNWOODY RD APT 6205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-4887
Country	:	US
Telephone Number	:	904-334-1818
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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Directions to “ STEPHANIE MOORE ” Practice Location

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