Individual
SHANNON SMITH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNNP
Contact information
Practice address
710 CENTER ST, COLUMBUS, GA 31901-1527
(706) 571-1692
(706) 660-6504
Mailing address
PO BOX 1038, COLUMBUS, GA 31902-1038
(706) 571-1692
(706) 660-6504
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
RN089911
GA
Other
Enumeration date
10/13/2008
Last updated
06/11/2012
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