MEDICARE: MS. LILLIAN C MOBLEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	RN087045	GA

General Provider Information

NPI Number	:	1790975001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILLIAN C MOBLEY RN

Provider Business Mailing Address
First Line	:	1900 THE EXCHANGE SE
Second Line	:	SUITE 420
City	:	ATLANTA
State	:	GA
Zip	:	30339-2022
Country	:	US
Telephone Number	:	678-460-0345
Fax Number	:	678-460-0350

Provider Business Practice Location Address
First Line	:	1900 THE EXCHANGE SE
Second Line	:	SUITE 420
City	:	ATLANTA
State	:	GA
Zip	:	30339-2022
Country	:	US
Telephone Number	:	678-460-0345
Fax Number	:	678-460-0350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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