Provider Demographics
NPI:1437152352
Name:MOBLEY, WILLIAM CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLIFFORD
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 VININGS ESTATES DR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5968
Mailing Address - Country:US
Mailing Address - Phone:563-505-5226
Mailing Address - Fax:
Practice Address - Street 1:499 VININGS ESTATES DR SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5968
Practice Address - Country:US
Practice Address - Phone:563-505-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079127208800000X
GA62918208800000X
NC2008-00149208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02835Medicare UPIN