Provider Demographics
NPI:1326193939
Name:COBB KIDNEY CENTER, PC
Entity Type:Organization
Organization Name:COBB KIDNEY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOY SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SRINADH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALACHARLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-303-5082
Mailing Address - Street 1:3606 HIGHLANDS PKWY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:678-303-5082
Mailing Address - Fax:678-303-5160
Practice Address - Street 1:3606 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:678-303-5082
Practice Address - Fax:678-303-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050239207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty