1245533132 NPI number — TY COBB HEALTHCARE SYSTEM, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245533132 NPI number — TY COBB HEALTHCARE SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TY COBB HEALTHCARE SYSTEM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245533132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
461 COOK STREET
Provider Business Mailing Address City Name:
ROYSTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30662-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-245-1200
Provider Business Mailing Address Fax Number:
706-245-1848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7850 ROYSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARNESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-245-1200
Provider Business Practice Location Address Fax Number:
706-245-1848
Provider Enumeration Date:
12/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
706-856-6170

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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