Provider Demographics
NPI:1619443975
Name:MOORE, BABETTE HARTIG (BS, RD, LD)
Entity Type:Individual
Prefix:
First Name:BABETTE
Middle Name:HARTIG
Last Name:MOORE
Suffix:
Gender:F
Credentials:BS, RD, LD
Other - Prefix:
Other - First Name:BARBI
Other - Middle Name:HARTIG
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, RD, LD
Mailing Address - Street 1:631 BESSEMER SUPER HWY
Mailing Address - Street 2:
Mailing Address - City:MIDFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35228-3013
Mailing Address - Country:US
Mailing Address - Phone:205-715-6142
Mailing Address - Fax:205-241-5235
Practice Address - Street 1:631 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-3013
Practice Address - Country:US
Practice Address - Phone:205-715-6142
Practice Address - Fax:205-241-5235
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty