Individual
MRS. CHASKA LASHAWN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
750 MOUNT ZION RD, JONESBORO, GA 30236-3002
(770) 960-8855
Mailing address
750 MOUNT ZION RD, JONESBORO, GA 30236-3002
(770) 778-9004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4012
GA
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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