Healthcare Provider Details

I. General information

NPI: 1316931462
Provider Name (Legal Business Name): JOE DICK MOBLEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 CORNERSTONE DR STE A
PARIS TN
38242-5812
US

IV. Provider business mailing address

1002 CORNERSTONE DR STE A
PARIS TN
38242-5812
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-8884
  • Fax: 731-642-8865
Mailing address:
  • Phone: 731-642-8884
  • Fax: 731-642-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD0000011608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: