Healthcare Provider Details

I. General information

NPI: 1568438505
Provider Name (Legal Business Name): JAMES B MOSELEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 POPLAR AVE SUITE 317
MEMPHIS TN
38117-4426
US

IV. Provider business mailing address

4646 POPLAR AVE SUITE 317
MEMPHIS TN
38117-4426
US

V. Phone/Fax

Practice location:
  • Phone: 901-268-5707
  • Fax: 901-374-0924
Mailing address:
  • Phone: 901-268-5707
  • Fax: 901-374-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE3549
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD13184
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: