Individual
MS. VANESSA JOSEPHINE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2612 DOGWOOD AVE, PT D19, THUNDERBOLT, GA 31404-3239
(912) 220-6689
Mailing address
2612 DOGWOOD AVE, PT D19, THUNDERBOLT, GA 31404-3239
(912) 220-6689
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/24/2013
Last updated
01/24/2013
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