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General NPI Number Information
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NPI Number | 1124369210
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Entity Type | Organization
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Legal Business Name | EAST COBB HEALTH
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 3939 ROSWELL RD STE 10
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City | MARIETTA
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State | GA
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Zip | 30062-8812
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Country | US
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Telephone | 770-509-6755
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Fax | 678-669-2695
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Provider Business Mailing Address
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Address Line | 3939 ROSWELL RD STE 10
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City | MARIETTA
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State | GA
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Zip | 30062-8812
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Country | US
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Telephone | 770-509-6755
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Fax | 678-669-2695
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON PERO
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Credential |
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Telephone | 770-509-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO08994
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License Number State | GA
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