Provider Demographics
NPI:1053403550
Name:MOSS, WILLIAM JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOEL
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21592
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0592
Mailing Address - Country:US
Mailing Address - Phone:423-756-0863
Mailing Address - Fax:706-937-2377
Practice Address - Street 1:1755 GUNBARREL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7137
Practice Address - Country:US
Practice Address - Phone:423-756-0863
Practice Address - Fax:706-937-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000007472207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716358Medicaid
TN3716358Medicare PIN
TN3164877Medicare PIN
TN3716358Medicaid
GAGRP6522Medicare PIN
GA16BBCNKMedicare PIN