Provider Demographics
NPI:1598470304
Name:MOORE, CARLTON ERIC
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:ERIC
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6485
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0025
Mailing Address - Country:US
Mailing Address - Phone:404-314-7914
Mailing Address - Fax:
Practice Address - Street 1:5585 DOE TROT TRL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4890
Practice Address - Country:US
Practice Address - Phone:404-314-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)