Healthcare Provider Details

I. General information

NPI: 1578181178
Provider Name (Legal Business Name): K AND C COBB MDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 TATE SPRINGS RD
LYNCHBURG VA
24501-1111
US

IV. Provider business mailing address

2007 TATE SPRINGS RD
LYNCHBURG VA
24501-1111
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-5321
  • Fax: 434-947-5324
Mailing address:
  • Phone: 434-947-5321
  • Fax: 434-947-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE COBB
Title or Position: OWNER/MD
Credential: MD
Phone: 434-947-5321