Provider Demographics
NPI:1306026380
Name:MOORE, ANNA MARIA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MOORE
Other - Last Name:JUST-BUDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:510 SWANSON RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-6900
Mailing Address - Country:US
Mailing Address - Phone:770-964-5230
Mailing Address - Fax:770-964-5260
Practice Address - Street 1:510 SWANSON RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-6900
Practice Address - Country:US
Practice Address - Phone:770-964-5230
Practice Address - Fax:770-964-5260
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU99283Medicare UPIN
GA35ZCHPPMedicare PIN