Provider Demographics
NPI:1215412754
Name:MOORE, SIERRA (PA)
Entity Type:Individual
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First Name:SIERRA
Middle Name:
Last Name:MOORE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1301 SIGMAN RD NE STE 100
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 SIGMAN RD NE STE 100
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3819
Practice Address - Country:US
Practice Address - Phone:770-760-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant