Provider Demographics
NPI:1427094465
Name:MOSS, FREDERICK M (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3480 PRESTON RIDGE RD STE 600
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5462
Mailing Address - Country:US
Mailing Address - Phone:770-300-0101
Mailing Address - Fax:770-300-0429
Practice Address - Street 1:249 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-213-0036
Practice Address - Fax:334-213-0166
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2018-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2003-03752085R0202X
TNMD373222085R0202X
AL000082842085R0202X
ALMD8284208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC79059Medicare UPIN