Provider Demographics
NPI:1558320358
Name:MOBLEY, ESTELLA LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:LEE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 BUCKBOARD TRL
Mailing Address - Street 2:DEPT 1029
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4057
Mailing Address - Country:US
Mailing Address - Phone:770-722-9762
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE STREET
Practice Address - Street 2:SUITE 1600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-253-6820
Practice Address - Fax:404-874-1249
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005567731Medicaid
R12357Medicare UPIN
GA0005567731Medicaid