Male or Other

George R. Moore M.D.

Specialist in Fayetteville, GA(View on Map)

Full Name

George Richard Moore M.D.

NPI Number

1235153586

NPI Type

Individual Provider

Gender

Male

Enumeration Date

07/27/2006

Specialties

(Taxonomies)

Code

174400000X

Primary Taxonomy

Yes

Licenses

State

Georgia

License Number

012525

Contact
Information

Purpose

Mailing
Location

Address

1265 HWY 54 W
1265 HWY 54 W

City

Fayetteville
Fayetteville

State

GA
GA

Postal Code

30214
30214

Country

US
US

Telephone Number

(770) 997-5714
(770) 997-5714

Identifiers

Identifier

00393225A

Identifier State

GA

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/24/2007

Provider Address

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