Individual
MR. GERRY DELAYNE MOORE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
85 RENDI LN, BAXLEY, GA 31513-6816
(912) 347-9043
(912) 367-0986
Mailing address
85 RENDI LN, BAXLEY, GA 31513-6816
(912) 347-9043
(912) 367-0986
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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