Healthcare Provider Details

I. General information

NPI: 1124384631
Provider Name (Legal Business Name): HELEN AMELIA MOSES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 BROWNFIELD WAY
SUMTER SC
29150-2254
US

IV. Provider business mailing address

2783 BROWNFIELD WAY
SUMTER SC
29150-2254
US

V. Phone/Fax

Practice location:
  • Phone: 803-464-3558
  • Fax:
Mailing address:
  • Phone: 803-464-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number77082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: