Organization
BILLY H MOSES JR MD LLC
Active
Parent organization
SOUTHEAST PRIMARY CARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST PRIMARY CARE CORPORATION
Authorized official
TONY M OSTEEN (CFO)
(912) 538-5314
Entity
Organization
Contact information
Practice address
2400 BELLEVUE RD, #11 ERIN OFFICE PARK, DUBLIN, GA 31021-2885
(478) 275-2454
(478) 275-0991
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003138212A
—
GA
Enumeration date
08/21/2013
Last updated
09/05/2014
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