Healthcare Provider Details

I. General information

NPI: 1790005403
Provider Name (Legal Business Name): WEST COBB HEALTH ADN REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MARY ELIZA TRCE NW SUITE 202
MARIETTA GA
30064-1094
US

IV. Provider business mailing address

3901 MARY ELIZA TRCE NW SUITE 202
MARIETTA GA
30064-1094
US

V. Phone/Fax

Practice location:
  • Phone: 770-485-3255
  • Fax: 770-693-7804
Mailing address:
  • Phone: 770-485-3255
  • Fax: 770-693-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007533
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER JOSEPH CAMPAGNA
Title or Position: CEO
Credential: D.C.
Phone: 678-699-3238