Healthcare Provider Details

I. General information

NPI: 1508126541
Provider Name (Legal Business Name): TY COBB MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 COOK ST
ROYSTON GA
30662-4003
US

IV. Provider business mailing address

PO BOX 589
ROYSTON GA
30662-0589
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-1936
  • Fax:
Mailing address:
  • Phone: 706-245-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: JOHN STEVEN BARBER
Title or Position: CFO
Credential:
Phone: 706-245-1936