Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 34905 | GA |
NPI | 1427513266 |
---|---|
Provider Name | Dr. Cynthia Ann Moore |
First Address | Decatur, GA 30030-5514 |
Second Address | Gainesville, GA 30501-3402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |