NPIMap

Individual provider Active NPI

Laura Noel Moore, M.D.

  • Family Medicine Physician
  • Peachtree City, GA
National Provider Identifier
1619926177
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
043094 Issued in GA
Practice address
100 Line Creek Dr
Peachtree City, GA 30269-1028
Phone
(770) 847-8786
NPI assigned
May 10, 2006
Last updated
Oct 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 043094 GA
Family Medicine Physician 207Q00000X MD60541847 WA
Family Medicine Physician 207Q00000X 043094 GA Primary

Addresses

Primary practice location

100 Line Creek Dr
Peachtree City, GA 30269-1028

Mailing address

7171 Highway 19 S
Zebulon, GA 30295-3598
Phone (770) 567-7293

Other practice location 1

1141 Beach Dr E
Port Orchard, WA 98366
Phone (360) 895-4710

Other identifiers 4

IdentifierTypeStateIssuer
043094OtherGALICENSE
1619926177OtherNPI
000788477NMedicaidGA
10636815OtherCAQH

Other names 1

  • Laura Noel Beverly Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040701000885 GA Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Emergency Medicine 9133106735 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Mercer University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians
Upson Family Physicians, LCGroup PAC ID 3072659242, 9 clinicians

Practice addresses (Care Compare)

1524 Lafayette Pkwy
Lagrange, GA 30241-2566
Phone (706) 530-2151

7171 Hwy 19 S
Zebulon, GA 30295-3598
Phone (770) 872-5020

915 W Gordon St
Suite B
Thomaston, GA 30286-3427
Phone (706) 647-7009

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60541847WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upson Family Physicians, LC Family Medicine CurrentSince Nov 1, 2021 Accepting new patients
Jasper Health Services, Inc. Family Medicine CurrentSince Feb 1, 2011 Accepting new patients
Wellstreet of Georgia PC CurrentSince Mar 1, 2020 Accepting new patients
Jasper Health Services Inc. CurrentSince Feb 1, 2011 Accepting new patients
Houston Hospitals Inc Current Accepting new patients
Morningside Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Health Services of Central Georgia, Inc Family Medicine PastSince Jun 1, 2004 Accepting new patients
Central Georiga Fertility Institute Past Accepting new patients
The Doctor's Office, LLC Family Medicine Past Accepting new patients
The Hospital Authority of Monroe County, Georgia Past Accepting new patients

Locations

2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941

1524 Lafayette Pkwy
Lagrange, GA 30241
Phone (706) 530-2151

898 College St
Monticello, GA 31064
Phone (706) 468-0988

100 Line Creek Dr
Peachtree City, GA 30269
Phone (770) 847-8786

1120 Morningside Dr
Perry, GA 31069
Phone (478) 218-1706

915 W Gordon St
#B
Thomaston, GA 30286
Phone (706) 647-7009

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

7171 Highway 19 S
Zebulon, GA 30295
Phone (770) 567-4600

Organizations & group practices 11

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1619926177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7171 HIGHWAY 19 S",
            "city": "ZEBULON",
            "state": "GA",
            "postal_code": "302953598",
            "telephone_number": "770-567-7293",
            "fax_number": "770-567-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LINE CREEK DR",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691028",
            "telephone_number": "770-847-8786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1141 Beach Dr E",
            "address_purpose": "LOCATION",
            "city": "Port Orchard",
            "state": "WA",
            "postal_code": "98366",
            "country_code": "US",
            "telephone_number": "360-895-4710",
            "fax_number": "360-895-4453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "LAURA",
        "middle_name": "NOEL",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "043094",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60541847",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "043094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "043094",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619926177",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000788477N",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10636815",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "BEVERLY",
            "middle_name": "NOEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peachtree City, GA

Sources for this page

Verify at the official NPI Registry.