Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN165228 | GA |
NPI | 1023269230 |
---|---|
Provider Name | Amanda S Moore |
First Address | Roswell, GA 30075-7100 |
Second Address | Atlanta, GA 30309-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 20/04/2012 |