Provider Demographics
NPI:1386763860
Name:COBB PAIN AND REHABILITATION
Entity type:Organization
Organization Name:COBB PAIN AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-988-0033
Mailing Address - Street 1:2359 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8638
Mailing Address - Country:US
Mailing Address - Phone:770-988-0033
Mailing Address - Fax:770-988-0220
Practice Address - Street 1:2359 WINDY HILL RD SE
Practice Address - Street 2:SUITE 320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8638
Practice Address - Country:US
Practice Address - Phone:770-988-0033
Practice Address - Fax:770-988-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty