Provider Demographics
NPI:1972572642
Name:COBB COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:COBB COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:770-514-2300
Mailing Address - Street 1:1650 COUNTY SERVICES PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008
Mailing Address - Country:US
Mailing Address - Phone:770-514-2300
Mailing Address - Fax:770-514-2811
Practice Address - Street 1:1650 COUNTY SERVICES PARKWAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008
Practice Address - Country:US
Practice Address - Phone:770-514-2300
Practice Address - Fax:770-514-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000456431CMedicaid
GA000456431KMedicaid
GA000058616AMedicaid
GA000459269AMedicaid
GA000051939AMedicaid
GA000548237AMedicaid
GA000647336AMedicaid
GA000548237AMedicaid
GA000647336AMedicaid