Individual
CLARA COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
227 ARROWHEAD TRL, KINGSTON, TN 37763-7003
(865) 376-4205
Mailing address
227 ARROWHEAD TRL, KINGSTON, TN 37763-7003
(865) 376-4205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD18478
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100021685
PHP TENNCARE
TN
01
—
134107
BLACK LUNG
TN
01
—
1520556
UNITED MINE WORKERS
TN
01
—
220019758
RR MEDICARE
TN
01
—
3048821
BLUE CROSS BLUE SHIELD TN
TN
01
—
62-1658-77
TAX ID#
TN
01
—
62159
SIGNATURE HEALTH ALLIANCE
TN
01
—
621658077
CHAMPUS
TN
01
—
7525265
CIGNA
TN
01
—
76828
PHP CARITEN
TN
01
—
HEALTHSOURCE
014F17649
TN
01
—
MD18478
MEDICAL LICENSE #
TN
Enumeration date
02/07/2007
Last updated
09/26/2011
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