Individual
EBONIE MONIQUE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3538 LANTERN VIEW LN, SCOTTDALE, GA 30079-6806
(470) 269-4271
Mailing address
3538 LANTERN VIEW LN, SCOTTDALE, GA 30079-6806
(470) 269-4271
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
Other
Enumeration date
09/11/2019
Last updated
09/11/2019
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