MEDICARE: DR. ELLIS MOSSADED M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	74500	GA

General Provider Information

NPI Number	:	1790195261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIS MOSSADED M.D.

Provider Business Mailing Address
First Line	:	6065 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4011
Country	:	US
Telephone Number	:	770-231-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 OLD HAMILTON PL
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30507-7892
Country	:	US
Telephone Number	:	770-532-2066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	04/08/2025

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