Healthcare Provider Details

I. General information

NPI: 1033278338
Provider Name (Legal Business Name): ANTHONY P MORESCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N WESTBERRY ST
SYLVESTER GA
31791-2125
US

IV. Provider business mailing address

302 N WESTBERRY ST
SYLVESTER GA
31791-2125
US

V. Phone/Fax

Practice location:
  • Phone: 229-776-7060
  • Fax: 229-299-4217
Mailing address:
  • Phone: 229-776-7060
  • Fax: 229-299-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number049146
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: