Provider Demographics
NPI:1043203342
Name:MOORE, DAVID K (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:2825 KEITH BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3936
Practice Address - Country:US
Practice Address - Phone:770-844-7494
Practice Address - Fax:770-844-7445
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA027875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00307271DMedicaid
GA00307271DMedicaid
GA08BBVZTMedicare PIN