Provider Demographics
NPI:1760260459
Name:MOBLEY, SANDS LEE
Entity Type:Individual
Prefix:
First Name:SANDS
Middle Name:LEE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 YOUNGIE FUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:AMBROSE
Mailing Address - State:GA
Mailing Address - Zip Code:31512-3673
Mailing Address - Country:US
Mailing Address - Phone:912-592-1129
Mailing Address - Fax:
Practice Address - Street 1:591 YOUNGIE FUSSELL RD
Practice Address - Street 2:
Practice Address - City:AMBROSE
Practice Address - State:GA
Practice Address - Zip Code:31512-3673
Practice Address - Country:US
Practice Address - Phone:912-592-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant