Provider Demographics
NPI:1942479530
Name:MOORE, DAVID KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5744
Mailing Address - Country:US
Mailing Address - Phone:912-826-6000
Mailing Address - Fax:912-826-6016
Practice Address - Street 1:100 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5744
Practice Address - Country:US
Practice Address - Phone:912-826-6000
Practice Address - Fax:912-826-6016
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1031086438Medicaid