Provider Demographics
NPI:1871504654
Name:MOFFET, DEBORAH ELDER (PA, DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELDER
Last Name:MOFFET
Suffix:
Gender:F
Credentials:PA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 CATION DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-7965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1208 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2220
Practice Address - Country:US
Practice Address - Phone:912-384-6276
Practice Address - Fax:912-389-1618
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4691363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA286742308OMedicaid