Provider Demographics
NPI:1639680457
Name:MOSES-UBOH, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:MOSES-UBOH
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 1:803 POWDER SPRINGS ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3649
Mailing Address - Country:US
Mailing Address - Phone:770-627-2571
Mailing Address - Fax:
Practice Address - Street 1:803 POWDER SPRINGS ST STE 12
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3649
Practice Address - Country:US
Practice Address - Phone:770-627-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management