Individual
MELISSA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6995 DORSEY EVERGREEN RD, FULTON, MS 38843-7743
(662) 397-0202
Mailing address
6995 DORSEY EVERGREEN RD, FULTON, MS 38843-7743
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
TA2287
MS
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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