Individual
MALI KHAMISSI SOBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4787 AUSTELL RD, AUSTELL, GA 30106-2001
(770) 875-6870
Mailing address
1268 RIDGECREST LN SE, APT/SUITE, SMYRNA, GA 30080-2664
(770) 875-6870
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82852
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82852
GA MEDICAL LICENSE
GA
Enumeration date
04/05/2017
Last updated
10/13/2020
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