Provider Demographics
NPI:1588952899
Name:MOSELEY, CAROL JOHNSON (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JOHNSON
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1831
Mailing Address - Country:US
Mailing Address - Phone:601-482-5067
Mailing Address - Fax:
Practice Address - Street 1:25117 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-9088
Practice Address - Country:US
Practice Address - Phone:601-774-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0657133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered