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General NPI Number Information
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NPI Number | 1164024840
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Entity Type | Individual
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Provider Name | ANN CHILDERS MOSS
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 4450 ROCKMART RD SE
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City | SILVER CREEK
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State | GA
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Zip | 30173-2438
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Country | US
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Telephone | 706-292-0106
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Fax | 706-292-0647
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Provider Business Mailing Address
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Address Line | 31 BRIDGEVIEW DR SE
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City | ROME
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State | GA
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Zip | 30161-8472
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Country | US
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Telephone | 706-331-0815
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Fax | 706-292-0647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 017632
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License Number State | GA
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