Organization
PROVIDENCE FAMILY MEDICINE CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARITA DARLENE MOBLEY M.D., MPH, MS (CEO)
(703) 593-6154
Entity
Organization
Contact information
Practice address
1787 BROAD STREET, PROVIDENCE FAMILY MEDICINE CLINIC, INC, LUMPKIN, GA 31815
(703) 593-6154
Mailing address
1787 BROAD ST., P.O. BOX 685, LUMPKIN, GA 31815
(703) 593-6154
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046872
GA
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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