Healthcare Provider Details

I. General information

NPI: 1407770316
Provider Name (Legal Business Name): ELIZABETH GRACE MOBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 REDMOND RD NW
ROME GA
30165-1415
US

IV. Provider business mailing address

109 MOUNTAIN HOME LOOP
CEDARTOWN GA
30125-4231
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-0291
  • Fax:
Mailing address:
  • Phone: 706-291-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN306255
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: