Provider Demographics
NPI:1235957036
Name:MOORE, AHKEEM SHAQUILLE SR (CNA)
Entity type:Individual
Prefix:MR
First Name:AHKEEM
Middle Name:SHAQUILLE
Last Name:MOORE
Suffix:SR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 NEW HORIZON
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1668
Mailing Address - Country:US
Mailing Address - Phone:404-625-4469
Mailing Address - Fax:
Practice Address - Street 1:1403 NEW HORIZON
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-1668
Practice Address - Country:US
Practice Address - Phone:404-625-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014246658376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty