MR. Gerry Delayne Moore SR.

NPI #1164773040 in Baxley, Georgia

Provider Information

NPI Number: 1164773040
Entity Type: Individual
Name: MR. Gerry Delayne Moore SR.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Driver
Enumeration Date: Oct 2, 2012
Last Updated: Oct 2, 2012

Practice Location

Address: 85 RENDI LN
City: Baxley
State: Georgia
ZIP Code: 31513-6816
Phone: (912) 347-9043

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary

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