Individual
DR. JACQUELINE MOYERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
210 HANNAHS MILL RD, THOMASTON, GA 30286-2801
(706) 646-4543
Mailing address
6326 CAPE COD DR, COLUMBUS, GA 31904-2916
(706) 570-1629
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1583
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000461469C
—
GA
01
—
1583
PSYCHOLOGY LICENSE
GA
01
—
PY4912
PSYCHOLOGY LICENSE
FL
Enumeration date
11/20/2006
Last updated
07/09/2007
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