Provider Demographics
NPI:1255836987
Name:MOSELY, DELEON
Entity Type:Individual
Prefix:MRS
First Name:DELEON
Middle Name:
Last Name:MOSELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 CLARKS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6577
Mailing Address - Country:US
Mailing Address - Phone:678-914-2437
Mailing Address - Fax:
Practice Address - Street 1:4648 CLARKS CREEK LN
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-6577
Practice Address - Country:US
Practice Address - Phone:678-914-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management