Individual
KESHIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
304 PIERCE AVE, MACON, GA 31204-2422
(478) 751-2825
(478) 751-2897
Mailing address
304 PIERCE AVE, MACON, GA 31204-2422
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN-124512
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58-0622971
TAX I.D. NUMBER
GA
Enumeration date
05/22/2008
Last updated
05/22/2008
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