Provider Demographics
NPI:1770583841
Name:MOULIER, JOSE EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EMMANUEL
Last Name:MOULIER
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 1:821 YOUNG WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7239
Mailing Address - Country:US
Mailing Address - Phone:912-756-4186
Mailing Address - Fax:912-435-6053
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:STE 1003
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-6100
Practice Address - Fax:912-435-6053
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61772084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry