Healthcare Provider Details

I. General information

NPI: 1619368107
Provider Name (Legal Business Name): GILDA MOSS-TRAORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 WINDY HILL RD SE STE 300
MARIETTA GA
30067-8621
US

IV. Provider business mailing address

2470 WINDY HILL RD SE STE 300
MARIETTA GA
30067-8621
US

V. Phone/Fax

Practice location:
  • Phone: 770-933-5328
  • Fax: 470-980-0507
Mailing address:
  • Phone: 770-933-5328
  • Fax: 470-980-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191759
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN191759
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: