Individual
MYESHA D MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
250 BRAY ST, ATHENS, GA 30601-2203
(706) 389-6789
Mailing address
155 MEADOW LN, HULL, GA 30646-3842
(678) 598-5945
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5241012
FL
Other
Enumeration date
02/14/2021
Last updated
02/14/2021
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