Provider Demographics
NPI:1780751297
Name:MOBILE HEALTHCARE
Entity type:Organization
Organization Name:MOBILE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:678-521-8928
Mailing Address - Street 1:4749 LIMESTONE LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-6484
Mailing Address - Country:US
Mailing Address - Phone:678-521-8928
Mailing Address - Fax:
Practice Address - Street 1:4749 LIMESTONE LN NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-6484
Practice Address - Country:US
Practice Address - Phone:678-521-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172907NP163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty