Healthcare Provider Details

I. General information

NPI: 1669729729
Provider Name (Legal Business Name): KIRK ANTONIO MOSES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SERGEANT PRENTISS DR
NATCHEZ MS
39120-4726
US

IV. Provider business mailing address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

V. Phone/Fax

Practice location:
  • Phone: 601-443-2100
  • Fax:
Mailing address:
  • Phone: 601-296-2090
  • Fax: 601-296-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25363
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24973
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: