Provider Demographics
NPI:1902836232
Name:MOORE, JOSEPH GRAY (ATC, EMT-I)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:GRAY
Last Name:MOORE
Suffix:
Gender:M
Credentials:ATC, EMT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1507
Mailing Address - Country:US
Mailing Address - Phone:336-275-5982
Mailing Address - Fax:
Practice Address - Street 1:300 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1507
Practice Address - Country:US
Practice Address - Phone:336-275-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer