Individual
DENNIS MILES MOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3651 WHEELER RD, AUGUSTA, GA 30909-6521
(706) 855-9860
(706) 860-7124
Mailing address
3756 ROSCOMMON S, AUGUSTA, GA 30907-4742
(706) 284-5670
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN077262
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000616228B
—
GA
01
—
10065595
AMERIGROUP
GA
01
—
430077077
RAILROAD MEDICARE
GA
05
—
AN0562
—
SC
Enumeration date
05/03/2006
Last updated
01/24/2017
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