Provider Demographics
NPI:1497728406
Name:MOORE, VICKI LYNN (CST/CFA)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:MOORE
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Gender:F
Credentials:CST/CFA
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Mailing Address - Street 1:80 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30145-2619
Mailing Address - Country:US
Mailing Address - Phone:770-842-1857
Mailing Address - Fax:770-606-0129
Practice Address - Street 1:1409 DUNWOODY PLACE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:770-594-1351
Practice Address - Fax:770-594-1381
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist