NPI 1215647573

Shelathum Moore

Practitioner Driver Fairburn, GA

Practice location

Address: 670 Birkdale Dr, Fairburn, GA 30213-2924
Phone: (678) 929-1123
Mailing address: 225 Market Place Connector # 1144, Peachtree City, GA 30269-3542

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 050219016 (GA)

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Registry record

NPI: 1215647573
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Nov 2022
Record last updated: 28 Nov 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.