Provider Demographics
NPI:1477858736
Name:GEORGIA PRO-HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:GEORGIA PRO-HEALTH PARTNERS LLC
Other - Org Name:SOUTH COBB PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-432-0234
Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-5700
Mailing Address - Country:US
Mailing Address - Phone:404-432-0234
Mailing Address - Fax:
Practice Address - Street 1:3065 S COBB DR SE
Practice Address - Street 2:SUITE B
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7809
Practice Address - Country:US
Practice Address - Phone:770-432-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty