Doctor Name: | CHARLES HARRELSON MOSS |
NPI Number: | 1841447406 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CRNP |
License Number: | 1-104360 |
Business Practice Address: | 201 Magnolia Ct Axis, AL - 365054715 |
Business Phone Number: | 2515105929 |
Business Fax Number: | |
Mailing Address: | 201 Magnolia Ct, AXIS |
State: | AL |
Postal Code: | 365054715 |
Phone Number: | 2515105929 |
Fax Number: | |
NPI Enumeration Date: | 08/25/2008 |
NPI Last Update Date: | 01/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-104360 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |