MEDICARE: COBB NEPHROLOGY HYPERTENSION ASSOCIATES, PC

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	207RN0300X	Nephrology Physician

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
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	03169	OTHER	GA	BCBS GROUP #

General Provider Information

NPI Number	:	1821036278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COBB NEPHROLOGY HYPERTENSION ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	4444 AUSTELL RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1844
Country	:	US
Telephone Number	:	678-460-2700
Fax Number	:	877-784-4013

Provider Business Practice Location Address
First Line	:	4444 AUSTELL RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1844
Country	:	US
Telephone Number	:	678-460-2700
Fax Number	:	877-784-4013

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	MRS. SAMANTHA GILLEY
Credential	:
Telephone Number	:	678-460-2718

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/14/2026

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