COBB NEPHROLOGY HYPERTENSION ASSOCIATES PC NPI 1821036278

NPI Information

NPI: 1821036278
Provider Name: COBB NEPHROLOGY HYPERTENSION ASSOCIATES, PC
Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

CLIA Number: 11D2043363

Address:
3875 AUSTELL RD
SUITE 101
AUSTELL, GA
ZIP 30106
Phone: (678) 460-2700
Get Directions

COBB NEPHROLOGY HYPERTENSION ASSOCIATES, PC is a nephrology internal medicine in Austell, GA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. COBB NEPHROLOGY HYPERTENSION ASSOCIATES, PC NPI is 1821036278. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3875 AUSTELL RD
SUITE 101
AUSTELL, GA
ZIP 30106-153
Phone: (678) 460-2700
Fax: (678) 909-3620

The provider's authorized official is Edgar L Wollam .
The authorized official title is President and has the following contact phone number (678) 460-2706.

The CLIA number assigned to this NPI record is 11D2043363 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2006 and was last updated on 7/15/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RN0300X	Internal Medicine	Nephrology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	300029262B	MEDICAID	GEORGIA
2	300029262I	MEDICAID	GEORGIA
3	000146187B	MEDICAID	GEORGIA
4	000495316B	MEDICAID	GEORGIA
5	000495316A	MEDICAID	GEORGIA
6	GRP339	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA
7	03169	OTHER	GEORGIA	BCBS GROUP #
8	000146187C	MEDICAID	GEORGIA
9	300029262C	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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