Individual
LESLIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
(404) 367-3558
Mailing address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
(404) 367-3558
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN227918
GA
Other
Enumeration date
09/08/2015
Last updated
09/05/2018
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