Individual
JILL ANN MABLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
660 W CROSSVILLE RD, SUITE 110, ROSWELL, GA 30075-7525
(678) 555-5555
Mailing address
PO BOX 708, LEBANON, GA 30146-0708
(678) 493-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
021581
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000788114D
—
GA
Enumeration date
04/25/2006
Last updated
06/13/2008
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