Provider Demographics
NPI:1659088995
Name:MOSS FAMILY HOLDINGS LLC
Entity Type:Organization
Organization Name:MOSS FAMILY HOLDINGS LLC
Other - Org Name:MOSS FAMILY HOLDINGS DIABETES CENTER OF WARNER ROBINS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-454-5335
Mailing Address - Street 1:3477 PINEY BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-3108
Mailing Address - Country:US
Mailing Address - Phone:229-454-5335
Mailing Address - Fax:
Practice Address - Street 1:530 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6308
Practice Address - Country:US
Practice Address - Phone:229-454-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy