Individual
SHELATHUM MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
670 BIRKDALE DR, FAIRBURN, GA 30213-2924
(678) 929-1123
Mailing address
225 MARKET PLACE CONNECTOR # 1144, PEACHTREE CITY, GA 30269-3542
(678) 929-1123
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
050219016
GA
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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