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NPI Code Detail

MEDICARE: EDWARD L. MOORE C.R.N.A.

MEDICARE: EDWARD L. MOORE C.R.N.A.
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
1367500000XCertified Registered Nurse AnesthetistRN057653GA

General Provider Information

NPI Number : 1861510463
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD L. MOORE C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 1031
Second Line :
City : DUBLIN
State : GA
Zip : 31040-1031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1826 VETERANS BLVD
Second Line :
City : DUBLIN
State : GA
Zip : 31021-3631
Country : US
Telephone Number : 478-272-1210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 11/05/2025

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