Individual
GEORGE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 S MAIN ST, MC COLL, SC 29570-2020
(843) 523-5751
Mailing address
225 S MAIN ST, MC COLL, SC 29570-2020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5711
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057119
—
SC
01
—
P00169807
RAILROAD MEDICARE PTAN
SC
Enumeration date
08/16/2006
Last updated
09/05/2017
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