Provider Demographics
NPI:1245326859
Name:MOORE, KAREN A (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1405 FRANKLIN ROAD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8705
Mailing Address - Country:US
Mailing Address - Phone:770-951-5400
Mailing Address - Fax:770-951-5408
Practice Address - Street 1:1405 FRANKLIN ROAD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8705
Practice Address - Country:US
Practice Address - Phone:770-951-5400
Practice Address - Fax:770-951-5408
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000563824AMedicaid
GA000563824AMedicaid