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General NPI Number Information
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NPI Number | 1356895353
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Entity Type | Individual
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Provider Name | TARA JO MOSES NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 321B GREENVILLE ST
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City | LAGRANGE
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State | GA
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Zip | 30241-3231
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Country | US
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Telephone | 678-810-1955
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Fax | 678-810-1955
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Provider Business Mailing Address
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Address Line | 2522 WARM SPRINGS RD
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City | COLUMBUS
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State | GA
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Zip | 31904-5640
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Country | US
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Telephone | 706-322-9313
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Fax | 706-322-9314
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN232791
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License Number State | GA
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