Provider Demographics
NPI:1003271305
Name:ROSS-MOORE, JOYCE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:ROSS-MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-1626
Mailing Address - Fax:912-644-3369
Practice Address - Street 1:961 E WINTHROPE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1839
Practice Address - Country:US
Practice Address - Phone:478-982-0120
Practice Address - Fax:478-982-0150
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily