Provider Demographics
NPI:1093225484
Name:MOORE, DARRI K
Entity Type:Individual
Prefix:
First Name:DARRI
Middle Name:K
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 TIDERACE CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-9701
Mailing Address - Country:US
Mailing Address - Phone:404-422-9834
Mailing Address - Fax:
Practice Address - Street 1:2636 MLK JR DR SW # 1222
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1634
Practice Address - Country:US
Practice Address - Phone:678-705-3828
Practice Address - Fax:404-393-9474
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty