Provider Demographics
NPI:1720827850
Name:MOSS, RAYMOND EARL II
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:EARL
Last Name:MOSS
Suffix:II
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 1:6718 BROWNS MILL CIR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4669
Mailing Address - Country:US
Mailing Address - Phone:706-594-3663
Mailing Address - Fax:
Practice Address - Street 1:6718 BROWNS MILL CIR
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-4669
Practice Address - Country:US
Practice Address - Phone:706-594-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician