Individual
DOUGLAS MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
207P00000X
Emergency Medicine Physician
1870621
NY
207P00000X
Emergency Medicine Physician
41178
GA
207P00000X
Emergency Medicine Physician
ME58453
FL
207R00000X
Internal Medicine Physician
Primary
041178
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000687574K
—
GA
01
—
110177668
RAILROAD MEDICARE
—
01
—
525985740
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/14/2006
Last updated
06/21/2010
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