Healthcare Provider Details

I. General information

NPI: 1558838532
Provider Name (Legal Business Name): ABIGAIL M COBB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY COBB NICKNAME

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/09/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEPUTY BILL CANTRELL MEMORIAL RD STE 100
CUMMING GA
30040-1943
US

IV. Provider business mailing address

3970 DEPUTY BILL CANTRELL MEMORIAL RD SUITE 100
CUMMING GA
30040
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax:
Mailing address:
  • Phone: 678-513-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN248172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: