MEDICARE: STEVEN L MOORE M.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	2080A0000X	Pediatric Adolescent Medicine Physician	030152	GA

General Provider Information

NPI Number	:	1972564979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN L MOORE M.D.

Provider Business Mailing Address
First Line	:	1245 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1807
Country	:	US
Telephone Number	:	706-868-0389
Fax Number	:	706-651-0729

Provider Business Practice Location Address
First Line	:	1245 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1807
Country	:	US
Telephone Number	:	706-868-0389
Fax Number	:	706-651-0729

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/08/2007

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