Provider Demographics
NPI:1578397097
Name:MORE, DOR (PA-C)
Entity type:Individual
Prefix:
First Name:DOR
Middle Name:
Last Name:MORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 MILL GLENN CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7144
Mailing Address - Country:US
Mailing Address - Phone:814-218-0855
Mailing Address - Fax:
Practice Address - Street 1:1220 CAROLINE ST NE # A-230
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2749
Practice Address - Country:US
Practice Address - Phone:167-871-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant