Healthcare Provider Details

I. General information

NPI: 1386078152
Provider Name (Legal Business Name): COBB PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 DALLAS HWY SW SUITE 300
MARIETTA GA
30064-6425
US

IV. Provider business mailing address

3405 DALLAS HWY SW SUITE 300
MARIETTA GA
30064-6425
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-5331
  • Fax: 770-425-0799
Mailing address:
  • Phone: 770-425-5331
  • Fax: 770-425-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: DEEDEE VARNER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 678-504-1199