Deborah Elder Moffet, P.A., D.C.
Individual provider Active NPI Medical Physician Assistant · Douglas, GA
NPI 1871504654 · NPPES record last updated Jan 15, 2018
Key facts
- NPI
- 1871504654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 4691 (GA)
- Practice address
- 1208 Ocilla Rd
Douglas, GA 31533-2220 - Phone
- (912) 384-6276
- Fax
- (912) 389-1618
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061205000313 | GA | Practitioner - Physician Assistant | 3779582580 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4691 | GA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachtree Hospice of Georgia, LLC | Current |
Accepting new patients | |
| Westside Surgery Center, LLC | Past | Accepting new patients | |
| Collins Cardiology | Past | Accepting new patients |
Locations
135 Gemini Cir
Ste 202
Birmingham, AL 35209
Phone (205) 949-0400
1233 Eagles Landing Pkwy
Ste Ab
Stockbridge, GA 30281
Phone (404) 480-3842
Interoperability endpoints
- deborah.moffet@4247.securemail.prognocis.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 4691 | GA | Yes |
Addresses
Primary practice location
1208 Ocilla Rd
Douglas, GA 31533-2220
Mailing address
1121 Cation Dr
Douglas, GA 31533-7965
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 286742308O | Medicaid | GA |
Other providers in Douglas, GA
- Margaret S. Minchew
- Aretha Mizell
- Joshua Brett Mizell
- Mobleys Discount Pharmacy Inc
- Mihai Mocanu
- John Boyd Moffet
- Denise E. Mooney
- Moore Optometry Services, Inc
- Moore Optometry Services, Inc
- Mark D Moore
All providers in Douglas, GA · Medical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.