Provider Demographics
NPI:1871118232
Name:MOBLEY, ALAN E (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 HOG MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4846
Mailing Address - Country:US
Mailing Address - Phone:706-769-6671
Mailing Address - Fax:
Practice Address - Street 1:2281 HOG MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4846
Practice Address - Country:US
Practice Address - Phone:706-769-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice