Healthcare Provider Details

I. General information

NPI: 1871696260
Provider Name (Legal Business Name): THE COBB FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W GIBSON ST
HARTWELL GA
30643-1847
US

IV. Provider business mailing address

PO BOX 280
HARTWELL GA
30643-0280
US

V. Phone/Fax

Practice location:
  • Phone: 706-856-6100
  • Fax: 706-856-6294
Mailing address:
  • Phone: 706-856-6100
  • Fax: 706-856-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number073-494
License Number StateGA

VIII. Authorized Official

Name: MR. JERRY R WISE
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 706-856-6113