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Organization
GA DIAGNOSTIC PROVIDERS LLC
Active
Organization
GA DIAGNOSTIC PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SHANE MOBLEY RRT (PRESIDENT)
(478) 972-8865
Entity
Organization
Contact information
Practice address
5400 RIVERSIDE DR STE 202, MACON, GA 31210-0818
(478) 787-0059
(855) 428-4597
Mailing address
5400 RIVERSIDE DR STE 202, MACON, GA 31210-0818
(478) 972-8865
(855) 428-4597
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
NULL
293D00000X
Physiological Laboratory
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
10/22/2020
Last updated
02/21/2025
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