Basic Information
| Provider Information | |||||||||
| NPI: | 1811137128 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COBB ENTERPRISES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 558 | ||||||||
| Address2: | |||||||||
| City: | ROYSTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306620558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063567800 | ||||||||
| FaxNumber: | 7063567828 | ||||||||
| Practice Location | |||||||||
| Address1: | 367 CLEAR CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | LAVONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305534173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063567800 | ||||||||
| FaxNumber: | 7063893951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7063893938 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.