Healthcare Provider Details

I. General information

NPI: 1346253309
Provider Name (Legal Business Name): JOHN L MOSERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MOSERI RD
DECATUR GA
30032-5116
US

IV. Provider business mailing address

1810 MOSERI RD
DECATUR GA
30032-5116
US

V. Phone/Fax

Practice location:
  • Phone: 404-289-8223
  • Fax: 404-289-8224
Mailing address:
  • Phone: 404-289-8223
  • Fax: 404-289-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number041344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: