Provider Demographics
NPI:1922316785
Name:MOSS, D'METRIC MAUDELL
Entity Type:Individual
Prefix:MRS
First Name:D'METRIC
Middle Name:MAUDELL
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 1:1397 NEW PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817-4041
Mailing Address - Country:US
Mailing Address - Phone:706-359-5741
Mailing Address - Fax:
Practice Address - Street 1:881 USS JAMES MADISON RAOD
Practice Address - Street 2:NAVAL SUBMARINE BASE
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:904-542-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide