Individual
MR. JEROME MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3044 ASHLY FOREST DR, SNELLVILLE, GA 30078-4524
(770) 896-1413
Mailing address
55 PAULA DR, PORTERDALE, GA 30014-5013
(770) 896-1413
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
E029658
GA
261QA0600X
Adult Day Care Clinic/Center
—
—
376K00000X
Nurse's Aide
CN0030028021
GA
Other
Enumeration date
06/29/2014
Last updated
02/20/2020
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