Provider Demographics
NPI:1447972484
Name:GREEN-MOORE, ANDRIAN JERNISE
Entity type:Individual
Prefix:MRS
First Name:ANDRIAN
Middle Name:JERNISE
Last Name:GREEN-MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 BLASS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6479
Mailing Address - Country:US
Mailing Address - Phone:260-410-0729
Mailing Address - Fax:
Practice Address - Street 1:2246 BLASS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6479
Practice Address - Country:US
Practice Address - Phone:260-410-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant