Healthcare Provider Details

I. General information

NPI: 1578926374
Provider Name (Legal Business Name): REBECCA G ALCOBA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 FIVE FORKS TRICKUM RD SW STE 102
LILBURN GA
30047-8975
US

IV. Provider business mailing address

4000 SHAKERAG HL SUITE 201
PEACHTREE CITY GA
30269-4047
US

V. Phone/Fax

Practice location:
  • Phone: 770-923-6400
  • Fax: 770-564-1697
Mailing address:
  • Phone: 770-486-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN228914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: