Provider Demographics
NPI:1477826493
Name:MOBILE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:MOBILE PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-614-0828
Mailing Address - Street 1:1171 LAUREL POINTE
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2859
Mailing Address - Country:US
Mailing Address - Phone:706-614-0828
Mailing Address - Fax:706-262-2871
Practice Address - Street 1:1171 LAUREL POINTE
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2859
Practice Address - Country:US
Practice Address - Phone:706-614-0828
Practice Address - Fax:706-262-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier