Healthcare Provider Details

I. General information

NPI: 1144291014
Provider Name (Legal Business Name): JOHN EDWARD MOSS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CHEVES ST SUITE 370
FLORENCE SC
29506-2716
US

IV. Provider business mailing address

901 E CHEVES ST PO BOX 477
FLORENCE SC
29506-2716
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-6229
  • Fax: 843-667-1758
Mailing address:
  • Phone: 843-667-6229
  • Fax: 843-667-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number10782
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10782
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number10091
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: