Matthew Douglas Moore, BSN, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN266385 Issued in GA

Practice address

88 Sparkleberry LN E
Dallas, GA 30132-7578

Phone

(770) 605-7982

NPI assigned

Sep 4, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Atlas Surgery Center of Buckhead, Inc

  • Ambulatory Surgical Clinic/Center
  • Atlanta, GA
  • NPI 1215069166
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1043045537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 SPARKLEBERRY LN E",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301327578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 SPARKLEBERRY LN E",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301327578",
            "telephone_number": "770-605-7982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MATTHEW",
        "middle_name": "DOUGLAS",
        "credential": "BSN, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "GA",
            "license": "RN266385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohammad Mehdi Momtahan, PH.D.
• Annette Moncion, NP
• Gabriela Monge, MS, NBC-HWC, CWP
• Katie Montgomery, MED
• Laura O Moore, BSN, MN, RN
• Meagan K Moore, LMT
• Jessica Wall Morin, D.M.D.
• Mary Kathleen Morris
• Sarah McNatt Morris
• Ivy Scarlett Morrison, CD-L

• Administrator Registered Nurse in Dallas, GA
• Providers in Dallas, GA by specialty
• Administrator Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.