Provider Demographics
NPI:1104009497
Name:COBBS, JENNIFER COLEMAN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLEMAN
Last Name:COBBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PERIMETER CENTER PL NE STE 150
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1284
Mailing Address - Country:US
Mailing Address - Phone:404-595-8488
Mailing Address - Fax:
Practice Address - Street 1:903 PEACHTREE ST NE UNIT 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3994
Practice Address - Country:US
Practice Address - Phone:678-782-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant