Healthcare Provider Details

I. General information

NPI: 1245533132
Provider Name (Legal Business Name): TY COBB HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 ROYSTON RD
CARNESVILLE GA
30521
US

IV. Provider business mailing address

PO BOX 247 461 COOK STREET
ROYSTON GA
30662-0247
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-1200
  • Fax: 706-245-1848
Mailing address:
  • Phone: 706-245-1200
  • Fax: 706-245-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DEANNA LEA PEARSON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 706-856-6170