Individual
STANLEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1921 RANSOM PLACE, ANTIOCH, TN 37013
(615) 586-9155
(615) 586-9155
Mailing address
1921 RANSOM PLACE, ANTIOCH, TN 37013
(615) 586-9155
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
05/05/2009
Last updated
01/31/2011
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