Organization
COBB MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA JETER (MANAGER)
(770) 437-6910
Entity
Organization
Contact information
Practice address
3903 S COBB DR SE, SUITE 200, SMYRNA, GA 30080-6342
(770) 437-6910
(770) 433-2380
Mailing address
3903 S COBB DR SE, SUITE 200, SMYRNA, GA 30080-6342
(770) 437-6910
(770) 433-2380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
GA
207R00000X
Internal Medicine Physician
—
GA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
GA
208M00000X
Hospitalist Physician
—
GA
363AM0700X
Medical Physician Assistant
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP4243
MEDICARE GROUP NUMBER
GA
Enumeration date
11/02/2006
Last updated
03/06/2008
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