Provider Demographics
NPI:1871571562
Name:MOORE, MELVIN R (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-496-9400
Mailing Address - Fax:770-496-9495
Practice Address - Street 1:2712 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2512
Practice Address - Country:US
Practice Address - Phone:770-496-5555
Practice Address - Fax:770-939-2887
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA016647207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00011327EMedicaid
GA00011327EMedicaid
GAD46183Medicare UPIN