Provider Demographics
NPI:1598960080
Name:MOORE, AUBREY GLYNN (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:GLYNN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
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Mailing Address - Street 1:143 HWY 32 BYPASS
Mailing Address - Street 2:MICHAEL S. DEEN M.D.,P.C.
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510
Mailing Address - Country:US
Mailing Address - Phone:912-632-8288
Mailing Address - Fax:912-632-3758
Practice Address - Street 1:143 HWY 32 BYP
Practice Address - Street 2:MICHAEL S. DEEN M.D.
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2757
Practice Address - Country:US
Practice Address - Phone:912-632-8288
Practice Address - Fax:912-632-3758
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2011-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA001560PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000098733AMedicare ID - Type UnspecifiedCHARLES E BAGLEY MD PC
D39328Medicare UPIN
110858020AMedicare ID - Type UnspecifiedCHARLES E BAGLEY MD PC