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Dr. Jorge Luis Moreno SR., MD
General Practice Physician in Jackson, Georgia
NPI 1518904242

Jorge Luis Moreno SR. is a General Practice Physician based in Jackson, GA. Jorge Luis Moreno SR. practices in Jackson, GA and has the professional credentials of MD. The NPI Number for Jorge Luis Moreno SR. is 1518904242 and holds a License No. 022255 (Georgia).

The current practice location address for Jorge Luis Moreno SR. is 375 Mcdonough Rd, Jackson, GA and can be reached out via phone at 770-775-4622 and via fax at 770-775-4132.

Location: 375 Mcdonough Rd, Jackson, GA, 30233-1509
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1518904242
Provider Name
Jorge Luis Moreno SR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
375 Mcdonough Rd, Jackson, GA, 30233-1509
Phone Number
770-775-4622
Fax Number
770-775-4132
Provider Enumeration Date
06/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00211549A 05 GA
institution
Provider Business Practice Location Address Details
Address
375 Mcdonough Rd
City
Jackson
State
Georgia
Zip
30233-1509
Phone Number
770-775-4622
Fax Number
770-775-4132
person
Provider Business Mailing Address Details
Address
375 Mcdonough Rd
City
Jackson
State
Georgia
Zip
30233-1509
Phone Number
770-775-4622
Fax Number
770-775-4132
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
022255 (Georgia)
Definition
Definition to come...
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