Individual
MS. RAVEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
154 CHIEF CT, ROCKMART, GA 30153-8020
(678) 994-6085
Mailing address
154 CHIEF CT, ROCKMART, GA 30153-8020
(678) 994-6085
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
J6G4Z3L9
GA
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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