Individual
BRANDIS ALYSIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
300 EAST HOSPITAL ROAD, INTERNAL MEDICINE DDEAMC, FORT GORDON, GA 30905
(706) 787-1745
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2021003701
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021003701
STATE LICENSURE
MO
Enumeration date
06/11/2019
Last updated
12/16/2022
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