Basic Information
| Provider Information | |||||||||
| NPI: | 1023269230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 WILDE GREEN DR | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300757100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705614585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 54 PEACHTREE PARK DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043516041 | ||||||||
| FaxNumber: | 4043551092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | RN165228 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.