Individual provider Active NPI

Karly Marie Kincaid Moss, PA

  • Physician Assistant
  • Duluth, GA
National Provider Identifier
1366781213
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006687 Issued in GA
Practice address
3850 Pleasant Hill Rd
Duluth, GA 30096-4807
Phone
(770) 814-8222
Fax
(678) 205-5111
NPI assigned
Feb 12, 2013
Last updated
Sep 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 006687 GA Primary

Addresses

Primary practice location

3850 Pleasant Hill Rd
Duluth, GA 30096-4807

Mailing address

1180 Resurgence Dr
Ste 100
Watkinsville, GA 30677-7211
Phone (706) 543-5858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130506000190 GA Practitioner - Physician Assistant 9133366461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Nova Southeastern Univ College of Dental Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Georgia Skin Cancer and Aestheitic Dermatology, LLCGroup PAC ID 0244328649, 25 clinicians

Practice addresses (Care Compare)

1046 Salem Walk Dr
Greensboro, GA 30642-3811
Phone (706) 543-5858

1180 Resurgence Dr
Suite 100
Watkinsville, GA 30677-7210

1180 Resurgence Dr
Suite 100
Watkinsville, GA 30677-7211
Phone 70654358583207

1656 Falls Rd
Suite B
Toccoa, GA 30577-2411
Phone (706) 543-5858

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.62 of 100Reported as group
Quality
78.23
Promoting interoperability
100
Improvement activities
40
Cost
73.84

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: karly@georgiaderm.emadirect.md

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1366781213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 RESURGENCE DR",
            "address_2": "STE 100",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777211",
            "telephone_number": "706-543-5858",
            "fax_number": "706-543-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 PLEASANT HILL RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964807",
            "telephone_number": "770-814-8222",
            "fax_number": "678-205-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCAID MOSS",
        "first_name": "KARLY",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-12",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

Verify at the official NPI Registry.