Provider Demographics
NPI:1932393626
Name:DR. WILLIAM J. MOSS
Entity Type:Organization
Organization Name:DR. WILLIAM J. MOSS
Other - Org Name:GYNECOLOGISTS ASSOCIATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-756-0863
Mailing Address - Street 1:PO BOX 21592
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0592
Mailing Address - Country:US
Mailing Address - Phone:423-756-0863
Mailing Address - Fax:706-937-2377
Practice Address - Street 1:1755 GUNBARREL RD STE 205
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3185
Practice Address - Country:US
Practice Address - Phone:423-756-0863
Practice Address - Fax:706-937-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7472207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716358Medicaid
GA160057061OtherMEDICARE RAILROAD
TN000046265OtherBCBS TN
TN3716358Medicare PIN
TN000046265OtherBCBS TN
GAGRP6522Medicare PIN
B03079Medicare UPIN
TN3164877Medicare PIN