Individual
DR. KELVIN JERRY MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 217-2207
Mailing address
83 SOUTHSIDE CHURCH ST, ELLIJAY, GA 30540-5400
(706) 636-6677
(706) 636-6678
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
GA 054634
GA
208M00000X
Hospitalist Physician
Primary
054634
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
839374814G
—
GA
Enumeration date
08/24/2006
Last updated
03/17/2018
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