Individual
MS. CHARLENE H. MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
107B FAHM ST, SAVANNAH, GA 31401-2391
(912) 651-2253
Mailing address
150 SCRANTON CONNECTOR, BRUNSWICK, GA 31525-0540
(912) 262-2300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN046402
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000632563C
—
GA
01
—
10063460
AMERIGROUP
—
Enumeration date
12/17/2006
Last updated
05/03/2019
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