Individual
MRS. STEPHANIE WIGGINS MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2121A BELLEVUE RD, DUBLIN, GA 31021-2998
(478) 272-1190
(478) 275-6509
Mailing address
218 CHASE DR, EAST DUBLIN, GA 31027-3395
(478) 275-7650
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R125330
GA
Other
Enumeration date
12/13/2005
Last updated
07/08/2007
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