Provider Demographics
NPI:1578894721
Name:WHITTEN, MOESHAE DEVON (PATIENT CARE TECH)
Entity Type:Individual
Prefix:MR
First Name:MOESHAE
Middle Name:DEVON
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:PATIENT CARE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ALTAMA AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4641
Mailing Address - Country:US
Mailing Address - Phone:912-265-4370
Mailing Address - Fax:
Practice Address - Street 1:2801 ALTAMA AVE APT 12
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4641
Practice Address - Country:US
Practice Address - Phone:912-265-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator