Mobile Mini Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MOBILE MINI CLINIC

Practice address

2225 Prickly Pear Walk
Lawrenceville, GA 30043-6344

Phone

(470) 207-1866

NPI assigned

Dec 3, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Taheerah Demby, FNP

Title

Ceo

Phone

(470) 207-1866

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1194362699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 PRICKLY PEAR WALK",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436344",
            "telephone_number": "219-201-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 PRICKLY PEAR WALK",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436344",
            "telephone_number": "470-207-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MINI CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-03",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "DEMBY",
        "authorized_official_first_name": "TAHEERAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "470-207-1866",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Marie Moates, OD
• Bobak Moazzami, MD
• Mary Cardina Mobbs, FNP-BC
• Mobile Care Physicians Group PC
• Mobile Convenience
• Joy Standridge Mock, LPC
• Modern Therapy
• Haresh Modha, D.D.S.
• Andrea Peyton Moe, PA
• Melanie Michelle Moebes

• Clinic/Center in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.