Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LSW0000007508 | TN |
NPI | 1003356262 |
---|---|
Provider Name | Allen Charles Moore |
First Address | Tuskegee, AL 36083-0105 |
Second Address | Tuskegee, AL 36083-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 06/03/2017 |