=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477572709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD M. MOSLEY PHARM. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 INDUSTRIAL BLVD
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31021-2981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-274-3147
-----------------------------------------------------
Fax | 478-274-3476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 NORTHWOOD TRL
-----------------------------------------------------
City | DUDLEY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31022-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-676-2955
-----------------------------------------------------
Fax | 478-274-3476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | RPH021572
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------