Healthcare Provider Details

I. General information

NPI: 1356267199
Provider Name (Legal Business Name): MOBILE LIFE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PRESCOTT ST
LOCUST GROVE GA
30248-2151
US

IV. Provider business mailing address

214 PRESCOTT ST
LOCUST GROVE GA
30248-2151
US

V. Phone/Fax

Practice location:
  • Phone: 770-369-0075
  • Fax:
Mailing address:
  • Phone: 770-369-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES CLARK
Title or Position: OWNER / MEMBER
Credential:
Phone: 770-369-0075