Individual
LASHANDA DENISE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5582 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3215
(404) 298-8998
Mailing address
5582 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3215
(404) 298-8998
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN249446
GA
363LF0000X
Family Nurse Practitioner
Primary
RN249446
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205306891
—
GA
Enumeration date
11/27/2018
Last updated
01/26/2021
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