Provider Demographics
NPI:1932353760
Name:S D MOORE AND ASSOCIATES
Entity Type:Organization
Organization Name:S D MOORE AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-608-5998
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30301-1247
Mailing Address - Country:US
Mailing Address - Phone:678-608-5998
Mailing Address - Fax:
Practice Address - Street 1:2000 POWERS FERRY RD
Practice Address - Street 2:SUITE 2 -3
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9476
Practice Address - Country:US
Practice Address - Phone:678-608-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies