Healthcare Provider Details

I. General information

NPI: 1104895572
Provider Name (Legal Business Name): COBB COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 SIX FLAGS DR
AUSTELL GA
30168-7064
US

IV. Provider business mailing address

1650 COUNTY SERVICES PKWY SW
MARIETTA GA
30008-4010
US

V. Phone/Fax

Practice location:
  • Phone: 678-385-1360
  • Fax: 678-385-1376
Mailing address:
  • Phone: 770-514-2361
  • Fax: 770-514-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: TYLER CARLSON
Title or Position: DIRECTOR OF ADMINISTRATION
Credential: CPA
Phone: 770-514-2342