Individual
BRYAN RUSSELL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PAA
Contact information
Practice address
2540 WINDY HILL RD SE, MARIETTA, GA 30067-8605
(470) 644-1274
(470) 644-1119
Mailing address
2540 WINDY HILL RD SE, MARIETTA, GA 30067-8605
(470) 644-1274
(470) 644-1119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002267B
—
GA
05
—
100002267C
—
GA
01
—
P00221726
RAILROAD MEDICARE
GA
Enumeration date
05/31/2006
Last updated
10/10/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us