Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1043661960 |
---|---|
Provider Name | Dr. Cameron Mosley |
First Address | Newnan, GA 30263-3302 |
Second Address | Augusta, GA 30912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 21/06/2019 |