MEDICARE: MOBILE HEALTHCARE PROVIDERS, LLC

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1528752383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE HEALTHCARE PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	3788 OXFORD CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-7700
Country	:	US
Telephone Number	:	716-472-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3788 OXFORD CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-7700
Country	:	US
Telephone Number	:	716-472-5201
Fax Number	:

Authorized Official
Title or Position	:	FNP/OWNER
Name	:	MS. STACEY LIZETTE SIMMONS
Credential	:	FNP
Telephone Number	:	716-472-5207

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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