Provider Demographics
NPI:1447588181
Name:MOORE, SUSAN B (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CHARLES GILMAN JR AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6290
Mailing Address - Country:US
Mailing Address - Phone:912-729-4554
Mailing Address - Fax:912-729-6056
Practice Address - Street 1:600 CHARLES GILMAN JR AVE
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6290
Practice Address - Country:US
Practice Address - Phone:912-729-4554
Practice Address - Fax:912-729-6056
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse