MEDICARE: MRS. ALISHA DENISE MOORE NP

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	363LF0000X	Family Nurse Practitioner	RN173142	GA

General Provider Information

NPI Number	:	1902912637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISHA DENISE MOORE NP

Provider Business Mailing Address
First Line	:	3931 MUNDY MILL RD
Second Line	:	SUITE C
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 MUNDY MILL RD
Second Line	:	SUITE C
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/15/2009

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