Healthcare Provider Details

I. General information

NPI: 1497495451
Provider Name (Legal Business Name): MARY MARGARET MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLIE MOSES

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

PO BOX 55407
BIRMINGHAM AL
35255-5407
US

V. Phone/Fax

Practice location:
  • Phone: 205-325-8507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47032
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: