Individual
DR. SANTRELL DENISE HART-MORELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.,M.P.H.
Contact information
Practice address
158 FAIRVIEW RD, SUITE B, ELLENWOOD, GA 30294-2795
(678) 289-5835
(678) 289-5837
Mailing address
158 FAIRVIEW RD, SUITE B, ELLENWOOD, GA 30294-2795
(678) 289-5835
(678) 289-5837
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
1761
GA
152W00000X
Optometrist
Primary
001761
GA
152WC0802X
Corneal and Contact Management Optometrist
001761
GA
152WP0200X
Pediatric Optometrist
001761
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00832818B
—
GA
05
—
00832818C
—
GA
Enumeration date
11/09/2006
Last updated
11/16/2012
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