PROVIDENCE FAMILY MEDICINE CLINIC, INC
NPI 1346590148
Family Medicine in Lumpkin, GA
About Providence Family Medicine Clinic, Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENCE FAMILY MEDICINE CLINIC, INC (NPI 1346590148) is a healthcare organization registered as a family medicine in Lumpkin, Georgia and active in the NPI registry since September 2012. The organization holds a CLIA Waiver certificate valid through June 9, 2027 and lists Sarita Darlene Mobley, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Providence Family Medicine Clinic, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Providence Family Medicine Clinic, Inc, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2060225
Providence Family Medicine Clinic, Inc · Lumpkin, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Providence Family Medicine Clinic, Inc's NPI number?
The NPI number for Providence Family Medicine Clinic, Inc is 1346590148. It was assigned to this organization in the NPPES registry on September 19, 2012.
Where is Providence Family Medicine Clinic, Inc located?
Providence Family Medicine Clinic, Inc is located at 1787 Broad Street Providence Family Medicine Clinic, Inc, Lumpkin, GA 31815. The listed phone number is (703) 593-6154.
What is Providence Family Medicine Clinic, Inc's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Providence Family Medicine Clinic, Inc enrolled in Medicare?
Yes. Providence Family Medicine Clinic, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Providence Family Medicine Clinic, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Providence Family Medicine Clinic, Inc, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Providence Family Medicine Clinic, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2060225) is associated with this NPI, valid through June 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Providence Family Medicine Clinic, Inc accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Providence Family Medicine Clinic, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Providence Family Medicine Clinic, Inc was last updated on September 19, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Providence Family Medicine Clinic, Inc · NPI 1346590148
Family Medicine organization in Lumpkin, Georgia. Organization record, active in the CMS NPPES registry since September 19, 2012.
## Identity
- **NPI:** 1346590148 (Entity type: Organization)
- **Enumerated:** September 19, 2012
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Sarita Mobley, CEO
## Practice location
- **Address:** 1787 BROAD STREET, PROVIDENCE FAMILY MEDICINE CLINIC, INC, Lumpkin, GA 31815
- **Phone:** (703) 593-6154
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 19, 2012
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1346590148) · Data from the CMS NPPES public registry.