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General NPI Number Information
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NPI Number | 1700905593
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Entity Type | Organization
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Legal Business Name | SOUTHERN SURGICAL PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 2406 BELLEVUE RD #11 ERIN OFFICE PARK
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City | DUBLIN
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State | GA
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Zip | 31021-2842
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Country | US
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Telephone | 478-275-2454
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Fax | 478-275-0991
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | DUBLIN
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State | GA
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Zip | 31040-0010
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Country | US
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Telephone | 478-275-2454
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Fax | 478-275-0991
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM (BILL) H MOSES JR.
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Credential | M.D.
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Telephone | 478-275-2454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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