Individual
ENGRA DE'ETE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, MS
Contact information
Practice address
521 S JEFFERSON ST, ASHBURN, GA 31714-5829
(229) 508-9551
Mailing address
521 S JEFFERSON ST, ASHBURN, GA 31714-5829
(229) 508-9551
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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