Basic Information
Provider Information
NPI: 1003271305
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSS-MOORE
FirstName: JOYCE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 460 MALL BLVD
Address2: STE B
City: SAVANNAH
State: GA
PostalCode: 314064801
CountryCode: US
TelephoneNumber: 9126441626
FaxNumber: 9126443369
Practice Location
Address1: 961 E WINTHROPE AVE
Address2:  
City: MILLEN
State: GA
PostalCode: 304421839
CountryCode: US
TelephoneNumber: 4789820120
FaxNumber: 4789820150
Other Information
ProviderEnumerationDate: 12/31/2015
LastUpdateDate: 01/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN214821GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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