NPIMap

Organization Active NPI

Kelvin Moss MD PC

  • Family Medicine Physician
  • Ellijay, GA
National Provider Identifier
1306003603
Registry record updated Sep 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
GA 054634 Issued in GA
Legal business name
KELVIN MOSS MD PC
Practice address
83 Southside Church St
Ellijay, GA 30540-5400
Phone
(706) 636-6677
NPI assigned
May 22, 2008
Last updated
Sep 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelvin Moss, MDNPI 1275640526
Title
Owner
Phone
(706) 636-6677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X GA 054634 GA Primary

Addresses

Primary practice location

83 Southside Church St
Ellijay, GA 30540-5400

Mailing address

83 Southside Church St
Ellijay, GA 30540-5400
Phone (706) 636-6677

National Provider Directory

National Provider Directory

Locations

83 Southside Church St
Ellijay, GA 30540
Phone (706) 635-3600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220313600000",
    "number": "1306003603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 SOUTHSIDE CHURCH ST",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305405400",
            "telephone_number": "706-636-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 SOUTHSIDE CHURCH ST",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305405400",
            "telephone_number": "706-636-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELVIN MOSS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-09-02",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-636-6677",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "GA 054634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.