# PROVIDENCE FAMILY MEDICINE CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346590148
- **Authorized official:** DR. SARITA DARLENE MOBLEY M.D., MPH, MS (CEO)
- **Authorized official phone:** (703) 593-6154

## Contact information

- **Practice address:** 1787 BROAD STREET, PROVIDENCE FAMILY MEDICINE CLINIC, INC, LUMPKIN, GA 31815
- **Practice address phone:** (703) 593-6154
- **Mailing address:** 1787 BROAD ST., P.O. BOX 685, LUMPKIN, GA 31815
- **Mailing address phone:** (703) 593-6154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 046872 | GA | Yes |

## Other

- **Enumeration date:** 09/19/2012
- **Last updated:** 09/19/2012