Provider Demographics
NPI:1083461297
Name:MOSLEY, CURTIS
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 STEWART PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2374
Mailing Address - Country:US
Mailing Address - Phone:404-539-0821
Mailing Address - Fax:
Practice Address - Street 1:5846 STEWART PKWY STE F
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2374
Practice Address - Country:US
Practice Address - Phone:404-539-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11D2303453291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory