Individual
JUSTIN M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4120 HIGHWAY 24, ANDERSON, SC 29626-5321
(864) 512-5830
(864) 224-4999
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-5830
(864) 224-4999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LL31007
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111684A
—
GA
05
—
310078
—
SC
01
—
P01170009
RR MEDICARE
SC
Enumeration date
06/20/2008
Last updated
02/16/2023
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