Basic Information
| Provider Information | |||||||||
| NPI: | 1740203769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSLEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 24146 | ||||||||
| Address2: | UNIVERSITY PHYSICIANS, PLLC | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392254146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845610 | ||||||||
| FaxNumber: | 6019845783 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 NORTH STATE STREET | ||||||||
| Address2: | DEPARTMENT OF MEDICINE/DIVISION OF GERIATRICS | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845610 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 06/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 32477 | MS | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | RR 680003439 | 01 | MS | RAILROAD | OTHER | 0112548 | 05 | MS | MEDICAID |