Individual
KENNETH MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.S.A.
Contact information
Practice address
2602 FALL CREEK LDG, LOGANVILLE, GA 30052-5877
(404) 310-2321
(404) 985-1694
Mailing address
PO BOX 888235, ATLANTA, GA 30356-0235
(404) 310-2321
(404) 985-1694
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
1558
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558
1558
GA
Enumeration date
03/19/2007
Last updated
07/08/2007
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