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Individual

ROCKSAN MOSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
508 N MAIN ST, HINESVILLE, GA 31313-2534
(801) 773-8644
(844) 848-5854
Mailing address
508 N MAIN ST, HINESVILLE, GA 31313-2534
(844) 848-5854

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004380
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10059174
AMERIGROUP
GA
05
638560621A
GA
05
638560621C
GA
05
638560621D
GA
05
638560621E
GA
01
9603746-1206
STATE LICENSE
UT
Enumeration date
03/23/2006
Last updated
05/19/2021
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