Healthcare Provider Details

I. General information

NPI: 1205808391
Provider Name (Legal Business Name): MOXLEY MEDICAL PRODUCTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S 8TH ST
GRIFFIN GA
30224-4214
US

IV. Provider business mailing address

608 S 8TH ST
GRIFFIN GA
30224-4214
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-2794
  • Fax: 770-233-0849
Mailing address:
  • Phone: 770-228-2794
  • Fax: 770-233-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ELLIS CLEMENTS SR.
Title or Position: OWNER
Credential: RPH
Phone: 770-228-2794