Providence Family Medicine Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

046872 Issued in GA

Legal business name

PROVIDENCE FAMILY MEDICINE CLINIC, INC

Practice address

1787 Broad Street
Providence Family Medicine Clinic, Inc
Lumpkin, GA 31815

Phone

(703) 593-6154

NPI assigned

Sep 19, 2012

Last updated

Sep 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sarita Darlene Mobley, M.D., MPH, MSNPI 1245300896

Title

Ceo

Phone

(703) 593-6154

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10309/brand/1/csg/1/fhir/r4

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarita Darlene Mobley, M.D.

  • Family Medicine Physician
  • Lumpkin, GA
  • NPI 1245300896
  Medicare reassignment NPD Authorized official
• Stacy Renee Cooper, NP

  • Family Nurse Practitioner
  • Columbus, GA
  • NPI 1720844061
  Medicare reassignment NPD
• Linda Faye Eason, FNP

  • Registered Nurse
  • Fort Benning, GA
  • NPI 1568544427
  Medicare reassignment NPD
• April Allen, NP

  • Gerontology Nurse Practitioner
  • Cranston, RI
  • NPI 1003388828

  GA

  Medicare reassignment NPD
• Jesse Lockhart Jr., PA-C

  • Physician Assistant
  • Columbus, GA
  • NPI 1316121106
  Medicare reassignment

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1346590148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1787 BROAD ST.",
            "address_2": "P.O. BOX 685",
            "city": "LUMPKIN",
            "state": "GA",
            "postal_code": "31815",
            "telephone_number": "703-593-6154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 BROAD STREET",
            "address_2": "PROVIDENCE FAMILY MEDICINE CLINIC, INC",
            "city": "LUMPKIN",
            "state": "GA",
            "postal_code": "31815",
            "telephone_number": "703-593-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY MEDICINE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "MOBLEY",
        "authorized_official_first_name": "SARITA",
        "authorized_official_middle_name": "DARLENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-593-6154",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., MPH, MS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "046872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Miller
• Catherine Reese Mobley
• Sarita Darlene Mobley, M.D.
• Octavia Dechandra Morris, NP-C
• Omacare Home Services, LLC
• William Lloyd Quam, NREMT
• Sundari Raju, MD
• Stewart County Board of Education
• Stewart County Board of Health
• Stewart County Fire & EMS

• Family Medicine Physician in Lumpkin, GA
• Providers in Lumpkin, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.