Individual
RUSSELL CHRISTOPHER MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P. A.
Contact information
Practice address
200 PATEWOOD DR STE C100, GREENVILLE, SC 29615-6322
(864) 454-7422
(864) 454-8265
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1368
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0728PA
—
SC
01
—
P00699136
RR MEDICARE
SC
Enumeration date
09/26/2008
Last updated
05/03/2023
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