Provider Demographics
NPI:1720120033
Name:COBB COUNTY COMMUNITY SERVICES BOARD
Entity type:Organization
Organization Name:COBB COUNTY COMMUNITY SERVICES BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-429-5000
Mailing Address - Street 1:3830 S COBB DR SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5532
Mailing Address - Country:US
Mailing Address - Phone:770-429-5000
Mailing Address - Fax:
Practice Address - Street 1:2051 GREENRIDGE RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1116
Practice Address - Country:US
Practice Address - Phone:770-434-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00599695AMedicaid
GA00603556AMedicaid
GA00961705BMedicaid
GA00603556BMedicaid