Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN214821 | GA |
NPI | 1003271305 |
---|---|
Provider Name | Joyce Ross-Moore |
First Address | Savannah, GA 31406-4801 |
Second Address | Millen, GA 30442-1839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2015 |
Last Update Date | 15/01/2016 |