# KELVIN MOSS MD PC

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

## Provider details

- **NPI number:** 1306003603
- **Authorized official:** KELVIN MOSS MD (OWNER)
- **Authorized official phone:** (706) 636-6677

## Contact information

- **Practice address:** 83 SOUTHSIDE CHURCH ST, ELLIJAY, GA 30540-5400
- **Practice address phone:** (706) 636-6677
- **Mailing address:** 83 SOUTHSIDE CHURCH ST, ELLIJAY, GA 30540-5400
- **Mailing address phone:** (706) 636-6677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | GA 054634 | GA | Yes |

## Other

- **Enumeration date:** 05/22/2008
- **Last updated:** 09/02/2008