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General NPI Number Information
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NPI Number | 1881923126
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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 | 12/16/2009
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1605 ROBERTA DR SW
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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 | 404-937-3850
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Fax | 770-419-3121
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Provider Business Mailing Address
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Address Line | 1605 ROBERTA DR SW
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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 | DIRECTOR OF OPERATIONS
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Name | MR. RORY MATHISEN
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Credential | MPH
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Telephone | 251-751-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 054389
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | GA
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