Provider Demographics
NPI:1124369210
Name:EAST COBB HEALTH
Entity Type:Organization
Organization Name:EAST COBB HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-509-6755
Mailing Address - Street 1:3939 ROSWELL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8812
Mailing Address - Country:US
Mailing Address - Phone:770-509-6755
Mailing Address - Fax:678-669-2695
Practice Address - Street 1:3939 ROSWELL RD STE 10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8812
Practice Address - Country:US
Practice Address - Phone:770-509-6755
Practice Address - Fax:678-669-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty