# APPALACHIAN ADDICTION MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275008856
- **Authorized official:** MR. EMAD MOUSA MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (304) 896-5200

## Contact information

- **Practice address:** 77 HOSPITAL DRIVE, SUITE 100 KRUGER BUILDING, LOGAN, WV 25601
- **Practice address phone:** (304) 896-5200
- **Practice address fax:** (304) 896-5300
- **Mailing address:** 77 HOSPITAL DRIVE, SUITE 100 KRUGER BUILDING, LOGAN, WV 25601
- **Mailing address phone:** (304) 896-5200
- **Mailing address fax:** (304) 896-5300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LA0401X | Addiction Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/10/2018
- **Last updated:** 10/10/2018