Individual
ETHEL LEE MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1511 W GORDON AVE, ALBANY, GA 31707-4843
(229) 449-4123
Mailing address
1511 W GORDON AVE, ALBANY, GA 31707-4843
(229) 449-4123
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
054598352
GA
Other
Enumeration date
10/26/2019
Last updated
10/26/2019
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