Healthcare Provider Details

I. General information

NPI: 1558354076
Provider Name (Legal Business Name): WILLIAM MOSE GEORGE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

IV. Provider business mailing address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-7010
  • Fax: 229-435-4022
Mailing address:
  • Phone: 229-883-7010
  • Fax: 229-435-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number012125
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: