Provider Demographics
NPI:1295720498
Name:WARD-MOORE, ALLISON M (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:WARD-MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-5646
Mailing Address - Country:US
Mailing Address - Phone:678-232-6618
Mailing Address - Fax:
Practice Address - Street 1:400 W SHERMAN ST STE 120
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5646
Practice Address - Country:US
Practice Address - Phone:903-785-4561
Practice Address - Fax:706-692-9364
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4414207V00000X
GA053200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA258734544AMedicaid
GA258734544CMedicaid
GA16BBCDDMedicare ID - Type Unspecified
GA258734544CMedicaid