Provider Demographics
NPI:1245300896
Name:MOBLEY, SARITA DARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:SARITA
Middle Name:DARLENE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 BROAD ST
Mailing Address - Street 2:P.O. BOX 685
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815-3045
Mailing Address - Country:US
Mailing Address - Phone:229-838-4900
Mailing Address - Fax:
Practice Address - Street 1:1787 BROAD ST
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815-3045
Practice Address - Country:US
Practice Address - Phone:229-838-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133221AMedicaid
GA20208I8256Medicare PIN