Healthcare Provider Details

I. General information

NPI: 1861308967
Provider Name (Legal Business Name): TERESA A COBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RASHEDA COBB TERRELL RN

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3753 WOODCOCK DR
HEPHZIBAH GA
30815-6476
US

IV. Provider business mailing address

3753 WOODCOCK DR
HEPHZIBAH GA
30815-6476
US

V. Phone/Fax

Practice location:
  • Phone: 706-799-1303
  • Fax:
Mailing address:
  • Phone: 706-799-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberPCH045277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: