Provider Demographics
NPI:1306627278
Name:MOORE, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-6310
Mailing Address - Country:US
Mailing Address - Phone:205-703-2547
Mailing Address - Fax:205-882-8125
Practice Address - Street 1:1220 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-6310
Practice Address - Country:US
Practice Address - Phone:205-703-2547
Practice Address - Fax:205-882-8125
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide