Healthcare Provider Details

I. General information

NPI: 1124947320
Provider Name (Legal Business Name): ADAM JOSEPH COBB DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ALICE COLEMAN DR
VIDALIA GA
30474-8860
US

IV. Provider business mailing address

118 ALICE COLEMAN DR
VIDALIA GA
30474-8860
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-2638
  • Fax:
Mailing address:
  • Phone: 478-237-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: