Organization

Mobile Mini Clinic

Clinic/Center in Lawrenceville, GA(View on Map)

Legal Business Name

Mobile Mini Clinic

NPI Number

1194362699

NPI Type

Organization

Enumeration Date

12/03/2019

Specialties

(Taxonomies)

Code

261Q00000X
261QH0100X

Primary Taxonomy

Yes
No

Contact
Information

Purpose

Mailing
Location

Address

2225 PRICKLY PEAR WALK
2225 PRICKLY PEAR WALK

City

Lawrenceville
Lawrenceville

State

GA
GA

Postal Code

30043-6344
30043-6344

Country

US
US

Telephone Number

(219) 201-3215
(470) 207-1866

Authorized Official

Name

Taheerah Demby

Title or Position

CEO

Telephone Number

(470) 207-1866

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/13/2020

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