Raven Moore
Technician, Pathology, Phlebotomy in Rockmart, GA. Individual provider (NPI-1).
NPI number1063253136
StatusActive
Last updated in NPPESJun 3, 2024
Details
- NPI
- 1063253136
- Entity type
- Individual (NPI-1)
- Name
- Ms. Raven Moore
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 3, 2024
- Certification date
- Jun 3, 2024
- Last updated
- Jun 3, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246RP1900X | Technician, Pathology, Phlebotomy | J6G4Z3L9 | GA | Yes |
Practice location
154 Chief CtRockmart, GA 30153-8020
Phone 678-994-6085
Mailing address
154 Chief CtRockmart, GA 30153-8020
Phone 678-994-6085
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