Provider Demographics
NPI:1265752273
Name:MOORE, DONNESHIA GABRIELLE (MD)
Entity type:Individual
Prefix:
First Name:DONNESHIA
Middle Name:GABRIELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNESHIA
Other - Middle Name:GABRIELLE
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1935
Mailing Address - Country:US
Mailing Address - Phone:252-823-4212
Mailing Address - Fax:252-824-1581
Practice Address - Street 1:101 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1935
Practice Address - Country:US
Practice Address - Phone:252-823-4212
Practice Address - Fax:252-824-1581
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2013-01713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program