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General NPI Number Information
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NPI Number | 1063697894
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Entity Type | Organization
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Legal Business Name | ALFRED RANDALL MOSS, M.D. P.A
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 101 PROFESSIONAL PARK
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City | GAFFNEY
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State | SC
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Zip | 29340-2319
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Country | US
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Telephone | 864-489-1446
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Fax | 864-489-4909
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 1375
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City | GAFFNEY
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State | SC
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Zip | 29342-1375
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Country | US
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Telephone | 864-489-1446
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Fax | 864-489-4909
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALFRED RANDALL MOSS
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Credential | M.D.
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Telephone | 864-489-1446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 009903
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License Number State | SC
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