Individual
LATECKA S MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
147 E MONTGOMERY XRD, SAVANNAH, GA 31406-4730
(912) 201-1701
Mailing address
147 E MONTGOMERY XRD, SAVANNAH, GA 31406-4730
(912) 201-1701
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
CO133923
GA
224P00000X
Prosthetist
CO133923
GA
225000000X
Orthotic Fitter
CO133923
GA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CO133923
GA
Other
Enumeration date
10/17/2023
Last updated
03/25/2025
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