Provider Demographics
NPI:1427647106
Name:MOORE, CHERONNE MONIQUE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERONNE
Middle Name:MONIQUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KIN FOLKS DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30667-1423
Mailing Address - Country:US
Mailing Address - Phone:706-372-0870
Mailing Address - Fax:
Practice Address - Street 1:14 KIN FOLKS DR
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:GA
Practice Address - Zip Code:30667-1423
Practice Address - Country:US
Practice Address - Phone:706-372-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator