Healthcare Provider Details

I. General information

NPI: 1700549334
Provider Name (Legal Business Name): AMBER S MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 LANDMARK DR STE 408
COLUMBIA SC
29204-4034
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-1922
  • Fax: 803-779-6729
Mailing address:
  • Phone: 813-695-6071
  • Fax: 843-569-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25221
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: