Provider Demographics
NPI:1306629654
Name:COBB MEDICAL SUPPLY
Entity type:Organization
Organization Name:COBB MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:ABDULRASHEED
Authorized Official - Last Name:KHALIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-964-3790
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7401
Mailing Address - Country:US
Mailing Address - Phone:470-964-3790
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7401
Practice Address - Country:US
Practice Address - Phone:470-964-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies