Active NPI
Monica Yvette Moore, M.D
- Pediatrics Physician
- Kennesaw, GA
National Provider Identifier
1932277092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 057897
- Practice address
- 205 Hawkins Store Rd NW
Kennesaw, GA 30144-6215 - Phone
- (770) 928-0862
- Fax
- (770) 928-2286
- NPI assigned
- Nov 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 057897 | GA | Primary |
Addresses
Primary practice location
205 Hawkins Store Rd NW
Kennesaw, GA 30144-6215
Mailing address
205 Hawkins Store Rd NW
Kennesaw, GA 30144-6215
Phone (770) 928-0862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 162413871A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057897 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Cardiovascular Medicine, LLC | Past | Accepting new patients |
Interoperability endpoints
- monica.moore.1@23699.direct.athenahealth.com
Organizations & group practices 1
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.
-
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- Marietta, GA
- NPI 1457320319
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407888000000",
"number": "1932277092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 HAWKINS STORE RD NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301446215",
"telephone_number": "770-928-0862",
"fax_number": "770-928-2286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 HAWKINS STORE RD NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301446215",
"telephone_number": "770-928-0862",
"fax_number": "770-928-2286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MONICA",
"middle_name": "YVETTE",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-30",
"last_updated": "2014-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "057897",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "162413871A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.