=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205907847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WESLEY MOSIER III PSY. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SIDNEY AND LAMONT STREET
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-742-5854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 GEORGIA AVENUE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-742-5854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | APPLIED FOR LICENSE
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------