Provider Demographics
NPI:1245294107
Name:MOSS, ALFRED RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:RANDALL
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2319
Mailing Address - Country:US
Mailing Address - Phone:864-489-1446
Mailing Address - Fax:864-489-4909
Practice Address - Street 1:101 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2319
Practice Address - Country:US
Practice Address - Phone:864-489-1446
Practice Address - Fax:864-489-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009903207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC3331Medicaid
SCPC3331Medicaid
SCD907012087Medicare PIN