Healthcare Provider Details

I. General information

NPI: 1619014099
Provider Name (Legal Business Name): PATRICIA B. MOSS APRN,CS,BC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2618 CHAUCER DR
AUGUSTA GA
30909-6588
US

IV. Provider business mailing address

2618 CHAUCER DR
AUGUSTA GA
30909-6588
US

V. Phone/Fax

Practice location:
  • Phone: 706-373-7900
  • Fax: 877-748-6950
Mailing address:
  • Phone: 706-373-7900
  • Fax: 877-748-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN043959
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC002573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: