Provider Demographics
NPI:1841502754
Name:MOORE, EVA KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:KATHERINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVA
Other - Middle Name:KATHERINE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1010 PRINCE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5805
Mailing Address - Country:US
Mailing Address - Phone:706-353-1630
Mailing Address - Fax:
Practice Address - Street 1:1010 PRINCE AVE STE 400
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-425-1400
Practice Address - Fax:706-548-0184
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST2355208600000X
GA074205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery