Provider Demographics
NPI:1568467611
Name:MOSELEY, JOHN LEIHUGH (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEIHUGH
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 HEMBREE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-475-7550
Mailing Address - Fax:770-343-9080
Practice Address - Street 1:1357 HEMBREE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-475-7550
Practice Address - Fax:770-343-9080
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA030153208800000X
GA030153208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000384194CMedicaid
GA000384194CMedicaid
GA34BDBMFMedicare PIN