Provider Demographics
NPI:1447394697
Name:MOORE, PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4354
Mailing Address - Country:US
Mailing Address - Phone:912-877-2228
Mailing Address - Fax:912-877-2463
Practice Address - Street 1:455S MAIN ST 202
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4354
Practice Address - Country:US
Practice Address - Phone:912-877-2228
Practice Address - Fax:912-877-2463
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology