Individual
BENNIE DEAN MOBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3999 HWY 34 EAST, SHARPSBURG, GA 30277
(770) 304-2025
(678) 854-9941
Mailing address
3999 HWY 34 EAST, SHARPSBURG, GA 30277
(770) 304-2025
(678) 854-9941
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT000912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00214629C
—
GA
01
—
41ZCDPR
MEDICARE PTAN
—
01
—
41ZCDSB
MEDICARE PTAN
GA
Enumeration date
10/21/2005
Last updated
10/28/2022
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