Provider Demographics
NPI:1669132742
Name:MORAN, JOANE MARIA
Entity type:Individual
Prefix:
First Name:JOANE
Middle Name:MARIA
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LAKEMOORE CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6068
Mailing Address - Country:US
Mailing Address - Phone:770-880-0853
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL ROAD
Practice Address - Street 2:SUITE 300 #5530
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:770-858-5975
Practice Address - Fax:770-858-5728
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy