MEDICARE: COBB COUNTY COMMUNITY SERVICES BOARD

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1295870376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COBB COUNTY COMMUNITY SERVICES BOARD

Provider Business Mailing Address
First Line	:	3830 S COBB DR SE
Second Line	:	SUITE 300
City	:	SMYRNA
State	:	GA
Zip	:	30080-5532
Country	:	US
Telephone Number	:	770-429-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 POWDER SPRINGS ST
Second Line	:	APT 701
City	:	MARIETTA
State	:	GA
Zip	:	30064-3665
Country	:	US
Telephone Number	:	770-499-2422
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TOD CITRON
Credential	:
Telephone Number	:	770-429-5000

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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