Healthcare Provider Details

I. General information

NPI: 1780948802
Provider Name (Legal Business Name): EMMANUEL MOSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1300 WILDCLIFF PKWY NE
ATLANTA GA
30329-3462
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4038
  • Fax:
Mailing address:
  • Phone: 404-904-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number67690
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number67690
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: