Provider Demographics
NPI:1649055377
Name:MOSLEY, KYLE (APC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SUGAR VALLEY TRL SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3826
Mailing Address - Country:US
Mailing Address - Phone:405-312-5648
Mailing Address - Fax:
Practice Address - Street 1:5901 PEACHTREE DUNWOODY RD STE A-225
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5382
Practice Address - Country:US
Practice Address - Phone:405-312-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health