MEDICARE: COBB COUNTY BOARD OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104895572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COBB COUNTY BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	1650 COUNTY SERVICES PKWY SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30008-4010
Country	:	US
Telephone Number	:	770-514-2361
Fax Number	:	770-514-2811

Provider Business Practice Location Address
First Line	:	875 SIX FLAGS DR
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-7064
Country	:	US
Telephone Number	:	678-385-1360
Fax Number	:	678-385-1376

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATION
Name	:	TYLER CARLSON
Credential	:	CPA
Telephone Number	:	770-514-2342

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/09/2010

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Directions to “COBB COUNTY BOARD OF HEALTH ” Practice Location

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