MEDICARE: TONY MOSES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023650231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY MOSES

Provider Business Mailing Address
First Line	:	4650 DAWN CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-6655
Country	:	US
Telephone Number	:	706-604-2901
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 DAWN CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-6655
Country	:	US
Telephone Number	:	706-604-2901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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Directions to “ TONY MOSES ” Practice Location

Language	Start Address	Practice Location

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