Individual
MADONNA MOORE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
16915 HIGHWAY 67, SUITE A, STATESBORO, GA 30458-5819
(912) 644-5300
(912) 644-5260
Mailing address
210 EAST DERENNE AVENUE, SAVANNAH, GA 31405-4801
(912) 644-5300
(912) 644-3369
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005351
GA
Other
Enumeration date
07/18/2008
Last updated
05/26/2017
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