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General NPI Number Information
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NPI Number | 1457214082
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HEALTH CENTER OF COBB
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1605 ROBERTA DR SW BLDG B
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City | MARIETTA
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State | GA
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Zip | 30008-3855
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Country | US
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Telephone | 770-419-3120
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 ROBERTA DR SW BLDG B
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City | MARIETTA
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State | GA
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Zip | 30008-3855
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Country | US
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Telephone | 770-419-3120
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Fax | 770-419-3121
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Authorized Official
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Title or Position | CEO/CFO
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Name | GAYLE CANTRELL NELSON
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Credential | CEO
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Telephone | 404-937-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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