Provider Demographics
NPI:1497851729
Name:MOORE, WILLIAM M III (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:MOORE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:12370 HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:LYERLY
Mailing Address - State:GA
Mailing Address - Zip Code:30730-5010
Mailing Address - Country:US
Mailing Address - Phone:706-895-4827
Mailing Address - Fax:
Practice Address - Street 1:12370 HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:LYERLY
Practice Address - State:GA
Practice Address - Zip Code:30730-5010
Practice Address - Country:US
Practice Address - Phone:706-895-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014534207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE72924Medicare UPIN