Organization
MOBILE MINI CLINIC
Active
Organization
MOBILE MINI CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAHEERAH DEMBY FNP (CEO)
(470) 207-1866
Entity
Organization
Contact information
Practice address
2225 PRICKLY PEAR WALK, LAWRENCEVILLE, GA 30043-6344
(470) 207-1866
Mailing address
2225 PRICKLY PEAR WALK, LAWRENCEVILLE, GA 30043-6344
(219) 201-3215
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
12/03/2019
Last updated
07/13/2020
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