Individual
LISAH MOBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PP
Contact information
Practice address
112 UTAH CIR APT B, ADEL, GA 31620-5286
(229) 563-0478
Mailing address
112 UTAH CIR APT B, ADEL, GA 31620-5286
(229) 563-0478
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
621410
GA
Other
Enumeration date
03/10/2017
Last updated
03/10/2017
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