Provider Demographics
NPI:1851155832
Name:GEORGIA MOBILE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:GEORGIA MOBILE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-453-2045
Mailing Address - Street 1:153 HILL LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2805
Mailing Address - Country:US
Mailing Address - Phone:770-453-2045
Mailing Address - Fax:770-264-4811
Practice Address - Street 1:153 HILL LN
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2805
Practice Address - Country:US
Practice Address - Phone:770-453-2045
Practice Address - Fax:770-264-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier