Individual
DR. KENNETH N MOATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1119 E LAMAR ST, AMERICUS, GA 31709-3762
(229) 924-4022
(229) 924-7133
Mailing address
1119 E LAMAR ST, AMERICUS, GA 31709-3762
(229) 924-4022
(229) 924-7133
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
001141
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000377891D
—
GA
05
—
0000377891E
—
GA
05
—
00377891A
—
GA
Enumeration date
09/23/2005
Last updated
11/06/2008
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