Individual
TONY MOSES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4650 DAWN CT, COLUMBUS, GA 31907-6655
(706) 604-2901
Mailing address
4650 DAWN CT, COLUMBUS, GA 31907-6655
(706) 604-2901
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049482255
—
GA
Enumeration date
10/09/2019
Last updated
10/09/2019
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