Provider Demographics
NPI:1326304486
Name:TY COBB REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:TY COBB REGIONAL MEDICAL CENTER LLC
Other - Org Name:TY COBB HEALTHCARE SYSTEM INC MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-356-7802
Mailing Address - Street 1:461 COOK ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-4003
Mailing Address - Country:US
Mailing Address - Phone:706-245-1850
Mailing Address - Fax:706-245-1937
Practice Address - Street 1:367 CLEAR CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553
Practice Address - Country:US
Practice Address - Phone:706-245-1850
Practice Address - Fax:706-245-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110027Medicare UPIN