Individual
STEPHANIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
5150 STILESBORO RD NW STE 430, KENNESAW, GA 30152-7759
(470) 746-4690
Mailing address
1615 COBB PKWY N APT 6204, MARIETTA, GA 30062-9205
(206) 930-4200
(206) 760-0266
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
010605
GA
Other
Enumeration date
05/02/2007
Last updated
10/21/2024
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