Healthcare Provider Details

I. General information

NPI: 1659088995
Provider Name (Legal Business Name): MOSS FAMILY HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S HOUSTON LAKE RD
WARNER ROBINS GA
31088-6308
US

IV. Provider business mailing address

3477 PINEY BLUFF RD
BAXLEY GA
31513-3108
US

V. Phone/Fax

Practice location:
  • Phone: 229-454-5335
  • Fax:
Mailing address:
  • Phone: 229-454-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL G MOSS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 229-454-5335