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General NPI Number Information
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NPI Number | 1407017965
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Entity Type | Organization
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Legal Business Name | CORRECTIONA MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 205 MCINTOSH PLACE DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7384
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Country | US
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Telephone | 770-719-3319
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Fax |
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Provider Business Mailing Address
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Address Line | 205 MCINTOSH PLACE DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7384
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Country | US
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Telephone | 770-719-3319
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MARCUS MOSELEY
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Credential | M.D
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Telephone | 404-853-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RN113001
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License Number State | GA
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