Provider Demographics
NPI:1619368107
Name:MOSS-TRAORE, GILDA (FNP)
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:
Last Name:MOSS-TRAORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 BERWICK CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2582
Mailing Address - Country:US
Mailing Address - Phone:404-293-5474
Mailing Address - Fax:
Practice Address - Street 1:65 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3095
Practice Address - Country:US
Practice Address - Phone:678-490-0080
Practice Address - Fax:678-490-0091
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191759363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily