Provider Demographics
NPI:1073077756
Name:MOORE, AUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5200
Mailing Address - Country:US
Mailing Address - Phone:505-486-1913
Mailing Address - Fax:
Practice Address - Street 1:805 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1603
Practice Address - Country:US
Practice Address - Phone:505-486-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program