Provider Demographics
NPI:1154117034
Name:MOBLEY, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SELLERS DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8764
Mailing Address - Country:US
Mailing Address - Phone:864-630-4485
Mailing Address - Fax:864-630-4485
Practice Address - Street 1:109 SELLERS DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-8764
Practice Address - Country:US
Practice Address - Phone:864-630-4485
Practice Address - Fax:864-630-4485
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse