Provider Demographics
NPI:1447284120
Name:MOSES, WILLIAM H JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:MOSES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:H
Other - Last Name:MOSES
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2400 BELLEVUE RD STE 11
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2899
Mailing Address - Country:US
Mailing Address - Phone:478-275-2454
Mailing Address - Fax:
Practice Address - Street 1:2400 BELLEVUE RD STE 11
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2899
Practice Address - Country:US
Practice Address - Phone:478-275-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025237208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053173282AOtherMEDICAID GROUP
GA000280541DMedicaid
GAD42232Medicare UPIN
GAGRP6076OtherMEDICARE GROUP