Individual
NICOLE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1120 15TH ST, BA-1565, AUGUSTA, GA 30912-0004
(706) 721-7602
(706) 721-7524
Mailing address
1120 15TH ST, BA-1565, AUGUSTA, GA 30912-0004
(706) 721-7602
(706) 721-7524
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2109
KY
133V00000X
Registered Dietitian
Primary
LD002941
GA
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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