Provider Demographics
NPI:1881282408
Name:MOORE, SIDNEY RHEE (NP)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:RHEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:SIDNEY
Other - Middle Name:RHEE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3496 INDIAN LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2708
Mailing Address - Country:US
Mailing Address - Phone:140-466-1578
Mailing Address - Fax:404-506-9006
Practice Address - Street 1:3496 INDIAN LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-2708
Practice Address - Country:US
Practice Address - Phone:404-661-5784
Practice Address - Fax:404-506-9006
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1019292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry