Raven Moore
Individual provider Active NPI Phlebotomy Technician · Rockmart, GA
NPI 1063253136 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1063253136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Phlebotomy Technician 246RP1900X
- License
- J6G4Z3L9 (GA)
- Practice address
- 154 Chief CT
Rockmart, GA 30153-8020 - Phone
- (678) 994-6085
- NPI assigned
- Jun 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J6G4Z3L9 | GA | MD | Phlebotomy Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | J6G4Z3L9 | GA | Yes |
Addresses
Primary practice location
154 Chief CT
Rockmart, GA 30153-8020
Mailing address
154 Chief CT
Rockmart, GA 30153-8020
Phone (678) 994-6085
Other providers in Rockmart, GA
- Gregory J. Matechak
- Trisha McAlister
- Lauren Neighbors Messer
- Mitchell Chiropractic & Wellness
- Douglas Nathan Mitchell
- Nursetrek Inc
- Savannah Tess Paris
- Jacob Roy Parker
- Alpita Patel
- Patriot Emergency Medical Services LLC
All providers in Rockmart, GA · Phlebotomy Technician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.