Individual
KEITH S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 JOHNSON FY RD NE, SUITE 165, ATLANTA, GA 30342-1709
(404) 446-2800
(404) 446-2809
Mailing address
1100 JOHNSON FY RD NE, SUITE 165, ATLANTA, GA 30342-1709
(404) 446-2800
(404) 446-2809
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M8850
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195354901
—
TX
01
—
8G6219
BC/BS TX#
TX
01
—
P00614620
RAILROAD MEDICARE
TX
Enumeration date
11/10/2005
Last updated
11/30/2016
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