Individual
MR. JIMMIE G MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3688 VETERANS MEMORIAL DR, SUITE 200, HATTIESBURG, MS 39401-8246
(601) 554-7400
(601) 554-7488
Mailing address
3688 VETERANS MEMORIAL DR, SUITE 200, HATTIESBURG, MS 39401-8246
(601) 554-7400
(601) 554-7488
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA028
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02274715
—
MS
Enumeration date
07/11/2006
Last updated
01/12/2010
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