Organization
SOUTH GEORGIA HEALTH GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS MOSS MD (MEMBER)
(229) 259-0032
Entity
Organization
Contact information
Practice address
814 NORTHWOOD PARK DR, VALDOSTA, GA 31602-1398
(229) 259-0032
(229) 259-0068
Mailing address
814 NORTHWOOD PARK DR, VALDOSTA, GA 31602-1398
(229) 259-0032
(229) 259-0068
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
789586476A
—
GA
Enumeration date
11/18/2008
Last updated
05/21/2012
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