Stacey Moore

Primary specialty

PharmacistTaxonomy code 183500000X

License

019515 Issued in GA

Practice address

111 8TH St E
Tifton, GA 31794-4099

Phone

(229) 382-4541

Fax

(229) 388-1909

NPI assigned

Aug 30, 2006

Last updated

Nov 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1942310404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 GOSS DR",
            "city": "ASHBURN",
            "state": "GA",
            "postal_code": "317145111",
            "telephone_number": "229-567-1161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 8TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944099",
            "telephone_number": "229-382-4541",
            "fax_number": "229-388-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "019515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05012015",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Ashburn",
            "affiliation": "N",
            "address_1": "111 8th St E",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317944099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Frederick Haygood Moore
• Holly Georgiana Moore, COTA/L
• Jessica Nichole Moore, FNP-C
• Jody Ann Moore
• Linda Moore, RD
• Brandi Moorman, FNP-C
• Casey Moran, DPT
• Emilee Marie Morehead, PHARMD
• Raymond G Moreno, M.D.
• Sandra Moretz, MNT

• Pharmacist in Tifton, GA
• Providers in Tifton, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; 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.