Individual
TERRY LAMAR COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1321 S MAIN ST, MOULTRIE, GA 31768-5809
(229) 985-2273
(229) 985-2270
Mailing address
1321 S MAIN ST, MOULTRIE, GA 31768-5809
(229) 985-2273
(229) 985-2270
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
20017139030
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52704189001
BLUE CROSS BLUE SHIELD
GA
Enumeration date
07/07/2006
Last updated
12/05/2007
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