Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 77082 | GA |
NPI | 1124384631 |
---|---|
Provider Name | Helen Amelia Moses |
First Address | Sumter, SC 29150-2254 |
Second Address | Sumter, SC 29150-2254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 28/04/2017 |