Provider Demographics
NPI:1871571869
Name:MOORE, JENNIFER LAWSON (MSN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAWSON
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN
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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 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE # 1185
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-223-0792
Practice Address - Fax:404-223-5815
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-01-07
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Provider Licenses
StateLicense IDTaxonomies
GARN144756363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA737542779Medicaid
GAP92403Medicare UPIN