Provider Demographics
NPI:1205804531
Name:MOBILITY EXPRESS OF GEORGIA, INC.
Entity type:Organization
Organization Name:MOBILITY EXPRESS OF GEORGIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FUJIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-998-9984
Mailing Address - Street 1:1580 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2289
Mailing Address - Country:US
Mailing Address - Phone:770-998-9984
Mailing Address - Fax:
Practice Address - Street 1:1580 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2289
Practice Address - Country:US
Practice Address - Phone:770-998-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-11
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA301755413332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4741730001Medicare ID - Type Unspecified