Individual
JORGE LUIS MORENO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
375 MCDONOUGH RD, JACKSON, GA 30233-1509
(770) 775-4622
(770) 775-4132
Mailing address
375 MCDONOUGH RD, JACKSON, GA 30233-1509
(770) 775-4622
(770) 775-4132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046792
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00885024A
—
GA
01
—
046792
MEDICAL LICENSE
GA
Enumeration date
05/27/2006
Last updated
07/01/2014
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