Organization
PEDIATRIC PULMONOLOGY OF CENTRAL GA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY R COBB (BILLING MGR)
(478) 755-0036
Entity
Organization
Contact information
Practice address
1062 FORSYTH ST, SUITE 2 C, MACON, GA 31201-8637
(478) 755-0036
(478) 755-1254
Mailing address
1062 FORSYTH ST, SUITE 2 C, MACON, GA 31201-8637
(478) 755-0036
(478) 755-1254
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000670535J
—
GA
01
—
319745
WELLCARE
—
Enumeration date
07/25/2011
Last updated
03/20/2012
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