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General NPI Number Information
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NPI Number | 1558976050
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Entity Type | Individual
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Provider Name | DENISHA L MOSS
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 448 HARRIS DR
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City | CONYERS
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State | GA
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Zip | 30012-6516
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Country | US
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Telephone | 706-254-8217
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Fax | 888-610-7172
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Provider Business Mailing Address
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Address Line | 448 HARRIS DR
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City | CONYERS
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State | GA
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Zip | 30012-6516
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Country | US
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Telephone | 706-254-8217
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Fax | 888-610-7172
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | PCHP015063
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License Number State | GA
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