Healthcare Provider Details

I. General information

NPI: 1477472868
Provider Name (Legal Business Name): MAJOR MOSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MAIN ST
YOUNG HARRIS GA
30582-4118
US

IV. Provider business mailing address

1550 MOSSY OAK DR
HIAWASSEE GA
30546-1932
US

V. Phone/Fax

Practice location:
  • Phone: 706-379-6677
  • Fax:
Mailing address:
  • Phone: 706-970-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124228
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: