Basic Information
| Provider Information | |||||||||
| NPI: | 1063520179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSER | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 SUNSET CIR STE C | ||||||||
| Address2: | P. O. BOX 2047 | ||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299855675 | ||||||||
| FaxNumber: | 2299855675 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299857977 | ||||||||
| FaxNumber: | 2298919387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 046462 | GA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 000806198A | 05 | GA | MEDICAID | 220024694 | 01 | GA | RAILROAD MEDICARE | OTHER | 728106 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER |