Provider Demographics
NPI:1356015283
Name:COBB, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:104 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1909
Mailing Address - Country:US
Mailing Address - Phone:912-399-5734
Mailing Address - Fax:
Practice Address - Street 1:104 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1909
Practice Address - Country:US
Practice Address - Phone:912-399-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health