Individual
GEORGE RICHARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1265 HWY 54 W, FAYETTEVILLE, GA 30214
(770) 997-5714
(770) 997-2810
Mailing address
1265 HWY 54 W, FAYETTEVILLE, GA 30214
(770) 997-5714
(770) 997-2810
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
012525
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00393225A
—
GA
Enumeration date
07/27/2006
Last updated
12/24/2007
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