Healthcare Provider Details

I. General information

NPI: 1063697894
Provider Name (Legal Business Name): ALFRED RANDALL MOSS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PROFESSIONAL PARK
GAFFNEY SC
29340-2319
US

IV. Provider business mailing address

101 PROFESSIONAL PARK
GAFFNEY SC
29340-2319
US

V. Phone/Fax

Practice location:
  • Phone: 864-489-1446
  • Fax: 864-489-4909
Mailing address:
  • Phone: 864-489-1446
  • Fax: 864-489-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFRED RANDALL MOSS
Title or Position: OWNER
Credential: MD
Phone: 864-909-4698