Provider Demographics
NPI:1871908095
Name:MOORE, AYJANAH RASHEEDA SHERIE (FNP- C, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:AYJANAH
Middle Name:RASHEEDA SHERIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP- C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 DUTCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7642
Mailing Address - Country:US
Mailing Address - Phone:404-944-1174
Mailing Address - Fax:
Practice Address - Street 1:3900 CROWN ROAD S.W.
Practice Address - Street 2:#162432
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30321
Practice Address - Country:US
Practice Address - Phone:404-944-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207446363LF0000X, 363LP0808X
GAAPRN207446363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily