Provider Demographics
NPI:1720195837
Name:MOSSELL, JAMES E III (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MOSSELL
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-391-3320
Mailing Address - Fax:229-391-3325
Practice Address - Street 1:2227 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-391-3320
Practice Address - Fax:229-391-3325
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044028207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA66BBBJFOtherMEDICARE
GA044028OtherLICENSE
GA000752056BMedicaid
GA000752056EMedicaid
GA044028OtherLICENSE
GAHOSP29Medicare PIN