Organization
HER WELLNESS CENTER, LLC
Active
Other names
HER Wellness Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICE MOORE MD (OBSTETRICIAN/GYNECOLOGIST)
(215) 498-7964
Entity
Organization
Contact information
Practice address
1763 HIGHWAY 196 W, HINESVILLE, GA 31313-8013
(215) 498-7964
Mailing address
1763 HIGHWAY 196 W, HINESVILLE, GA 31313-8013
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
67050
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003119950D
—
GA
Enumeration date
06/09/2017
Last updated
06/09/2017
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