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Individual

JOHN MOORE SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
421 12TH ST, COLUMBUS, GA 31901-2522
(706) 494-7776
(706) 494-7076
Mailing address
9443 MIDLANDWOODS DR., MIDLAND, GA 31820
(706) 561-5416

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
179077
GA

Other

Enumeration date
09/10/2008
Last updated
09/10/2008
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