Individual
JENNIFER E. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1984 PEACHTREE RD NW STE 515, ATLANTA, GA 30309-5219
(404) 351-1745
(404) 351-7121
Mailing address
2455 HARRINGTON DR, DECATUR, GA 30033-4903
(404) 315-6081
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
003360
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000534A
—
GA
Enumeration date
01/19/2006
Last updated
01/27/2021
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