Healthcare Provider Details

I. General information

NPI: 1003583949
Provider Name (Legal Business Name): KERRI LEIGH COBB HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7213 COPPERFIELD DR
MONTGOMERY AL
36117-7101
US

IV. Provider business mailing address

7213 COPPERFIELD DR
MONTGOMERY AL
36117-7101
US

V. Phone/Fax

Practice location:
  • Phone: 334-262-7553
  • Fax: 334-261-3132
Mailing address:
  • Phone: 334-262-7553
  • Fax: 334-261-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2326
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: