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Individual

DR. JAMES R MOULTON II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2069 TERON TRCE, SUITE 100, DACULA, GA 30019-1665
(770) 995-9100
(770) 822-9444
Mailing address
2069 TERON TRACE, SUITE 100, DACULA, GA 30019-8716
(770) 995-9100
(770) 822-9444

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
043436
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000750362B
GA
01
309499
WELLCARE MEDICAID
GA
01
4804710
CIGNA
GA
01
5554055
AETNA
GA
Enumeration date
12/17/2007
Last updated
02/10/2011
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