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EBONIE MONIQUE MOORE
>> Contractor >> Other Service ProvidersRegistrant NPI Number: 1861041865
Individual Registrant: EBONIE MONIQUE MOORE
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
3538 LANTERN VIEW LN SCOTTDALE, GA 30079-6806 US
Tel: 470-269-4271 Fax: --
Tel: 470-269-4271 Fax: --
Contact information for business:
3538 LANTERN VIEW LN SCOTTDALE, GA 30079-6806 US
Tel: 470-269-4271 Fax: --
Tel: 470-269-4271 Fax: --
Registration Information:
NPI: 1861041865
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 171W00000X | Other Service Providers Contractor | GA |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
