Healthcare Provider Details

I. General information

NPI: 1467303081
Provider Name (Legal Business Name): COBY HANCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # GC5114
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1703 GOODRICH ST
AUGUSTA GA
30904-1200
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7330
  • Fax:
Mailing address:
  • Phone: 904-310-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: