Provider Demographics
NPI:1568516425
Name:MOORE, GERALDINE L (ARNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:L
Other - Last Name:DUNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5609 MOUNTAIN VIEW PT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6022
Mailing Address - Country:US
Mailing Address - Phone:770-469-5494
Mailing Address - Fax:
Practice Address - Street 1:5805 STATE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8220
Practice Address - Country:US
Practice Address - Phone:678-495-0162
Practice Address - Fax:678-495-0163
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA086734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily