Individual
AUSTIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
805 NICHOLS RD, SUWANEE, GA 30024-1603
(505) 486-1913
Mailing address
5010 W BROAD ST, SUGAR HILL, GA 30518-5200
(505) 486-1913
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/26/2019
Last updated
06/23/2021
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