Provider Demographics
NPI:1366781213
Name:KINCAID MOSS, KARLY MARIE (PA)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:MARIE
Last Name:KINCAID MOSS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1180 RESURGENCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7211
Mailing Address - Country:US
Mailing Address - Phone:706-543-5858
Mailing Address - Fax:706-543-2050
Practice Address - Street 1:3850 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4807
Practice Address - Country:US
Practice Address - Phone:770-814-8222
Practice Address - Fax:678-205-5111
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2021-09-28
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Provider Licenses
StateLicense IDTaxonomies
GA006687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant