Provider Demographics
NPI:1376662866
Name:MORAN, AUDRA JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:JEAN
Last Name:MORAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HAMILTON AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3778
Mailing Address - Country:US
Mailing Address - Phone:404-888-0666
Mailing Address - Fax:404-888-0590
Practice Address - Street 1:650 HAMILTON AVE SE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3778
Practice Address - Country:US
Practice Address - Phone:404-888-0666
Practice Address - Fax:404-888-0590
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor