Provider Demographics
NPI:1578880308
Name:MOORE, ADAMS W (MD)
Entity Type:Individual
Prefix:
First Name:ADAMS
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N BROAD ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5201
Mailing Address - Country:US
Mailing Address - Phone:701-291-2661
Mailing Address - Fax:
Practice Address - Street 1:901 N BROAD ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5201
Practice Address - Country:US
Practice Address - Phone:706-291-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32325390200000X
GA755392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program