1679069231 NPI number — VASHAWN RENEE MOSLEY FNPC

Table of content: VASHAWN RENEE MOSLEY FNPC (NPI 1679069231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679069231 NPI number — VASHAWN RENEE MOSLEY FNPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSLEY
Provider First Name:
VASHAWN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679069231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLQUITT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39837-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-758-5902
Provider Business Mailing Address Fax Number:
229-758-8227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL AUTHORITY OF MILLER COUNTY
Provider Second Line Business Practice Location Address:
MILLER COUNTY HOSPITAL, 209 N. CUTHBERT STREET
Provider Business Practice Location Address City Name:
COLQUITT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-758-5902
Provider Business Practice Location Address Fax Number:
229-758-8227
Provider Enumeration Date:
07/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN203847 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN203847 . This is a "ADVANCED PRACTICE NP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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