Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | PSY0002953 | GA |
NPI | 1124065818 |
---|---|
Provider Name | Anna B Moore |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |