Provider Demographics
NPI:1942763735
Name:MOSELEY, JAMES MARK
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-4603
Mailing Address - Country:US
Mailing Address - Phone:706-716-1598
Mailing Address - Fax:
Practice Address - Street 1:539 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-4603
Practice Address - Country:US
Practice Address - Phone:706-716-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)