Individual
LINDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 353-7722
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD001273
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD001273
STATE LICENSE NUMBER
GA
Enumeration date
11/14/2006
Last updated
07/08/2007
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