Healthcare Provider Details

I. General information

NPI: 1437152352
Provider Name (Legal Business Name): WILLIAM CLIFFORD MOBLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 VININGS ESTATES DR SE
MABLETON GA
30126-5968
US

IV. Provider business mailing address

499 VININGS ESTATES DR SE
MABLETON GA
30126-5968
US

V. Phone/Fax

Practice location:
  • Phone: 563-505-5226
  • Fax:
Mailing address:
  • Phone: 563-505-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036079127
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number62918
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2008-00149
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: