Individual
LAURA O MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, MN, RN
Contact information
Practice address
440 THOMAS RD, DALLAS, GA 30132-7703
(678) 571-5378
Mailing address
440 THOMAS RD, DALLAS, GA 30132-7703
(678) 571-5378
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
636351
GA
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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