Basic Information
| Provider Information | |||||||||
| NPI: | 1265473656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS IMMEDIATE MED OF COBB, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2481 GEORGE BUSBEE PKWY NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301444961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704230000 | ||||||||
| FaxNumber: | 7704230131 | ||||||||
| Practice Location | |||||||||
| Address1: | 2481 GEORGE BUSBEE PKWY NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301444961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704230000 | ||||||||
| FaxNumber: | 7704230131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | HART | ||||||||
| AuthorizedOfficialFirstName: | LORETTA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | BRANCH MANAGER/CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7704230000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.