1093877037 NPI number — MISS BARBARA JOHNAE MOORER MA, CADCII, ICADC

Table of content: MISS BARBARA JOHNAE MOORER MA, CADCII, ICADC (NPI 1093877037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093877037 NPI number — MISS BARBARA JOHNAE MOORER MA, CADCII, ICADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORER
Provider First Name:
BARBARA
Provider Middle Name:
JOHNAE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA, CADCII, ICADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093877037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2872 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST POINT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30344-3254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-310-1133
Provider Business Mailing Address Fax Number:
888-830-5578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2872 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-310-1133
Provider Business Practice Location Address Fax Number:
888-830-5578
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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