Provider Demographics
NPI:1003799263
Name:MOORE, MARILYN DORIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:DORIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SPRING HOUSE CV NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1187
Mailing Address - Country:US
Mailing Address - Phone:404-291-3447
Mailing Address - Fax:
Practice Address - Street 1:412 SPRING HOUSE CV NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1187
Practice Address - Country:US
Practice Address - Phone:404-291-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA276982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry