Provider Demographics
NPI:1679575005
Name:MOORE, EFRIM CASSIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:EFRIM
Middle Name:CASSIUS
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 1:1320 OAKSIDE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2475
Mailing Address - Country:US
Mailing Address - Phone:770-479-2322
Mailing Address - Fax:770-720-7695
Practice Address - Street 1:1320 OAKSIDE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2475
Practice Address - Country:US
Practice Address - Phone:770-479-2322
Practice Address - Fax:770-720-7695
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033780207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000451019FMedicaid
F25614Medicare UPIN