Healthcare Provider Details

I. General information

NPI: 1083711691
Provider Name (Legal Business Name): TY COBB HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 FRANKLIN SPRINGS ST
ROYSTON GA
30662-3934
US

IV. Provider business mailing address

521 FRANKLIN SPRINGS ST PO BOX 589
ROYSTON GA
30662-3934
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-5071
  • Fax: 706-245-1411
Mailing address:
  • Phone: 706-245-5071
  • Fax: 706-245-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number059-521
License Number StateGA

VIII. Authorized Official

Name: MISS KIMBERLY A MASSEY
Title or Position: CONTROLLER
Credential:
Phone: 706-245-1290