Provider Demographics
NPI:1851164776
Name:MOSS, IRIANNA
Entity Type:Individual
Prefix:
First Name:IRIANNA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WARD HILL CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-3300
Mailing Address - Country:US
Mailing Address - Phone:478-298-2646
Mailing Address - Fax:
Practice Address - Street 1:116 WARD HILL CHURCH LN
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-3300
Practice Address - Country:US
Practice Address - Phone:478-298-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide