Individual
MRS. LAURA NOEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 LINE CREEK DR, PEACHTREE CITY, GA 30269-1028
(770) 847-8786
Mailing address
7171 HIGHWAY 19 S, ZEBULON, GA 30295-3598
(770) 567-7293
(770) 567-0614
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
043094
GA
207Q00000X
Family Medicine Physician
Primary
043094
GA
207Q00000X
Family Medicine Physician
MD60541847
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000788477N
—
GA
01
—
043094
LICENSE
GA
01
—
10636815
CAQH
—
01
—
1619926177
NPI
—
Enumeration date
05/10/2006
Last updated
10/06/2023
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