Healthcare Provider Details

I. General information

NPI: 1811944705
Provider Name (Legal Business Name): COBB ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

PO BOX 155
AUSTELL GA
30168-1002
US

V. Phone/Fax

Practice location:
  • Phone: 770-874-1911
  • Fax:
Mailing address:
  • Phone: 770-578-1800
  • Fax: 770-578-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: YVETTE STANLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-874-1911