Provider Demographics
NPI:1508343021
Name:COCABO, JEANNETTE CHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:CHUA
Last Name:COCABO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNETTE
Other - Middle Name:CHUA
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:127 ETOWAH DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3701
Mailing Address - Country:US
Mailing Address - Phone:770-606-8095
Mailing Address - Fax:
Practice Address - Street 1:20 COLLINS DR STE B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8533
Practice Address - Country:US
Practice Address - Phone:770-607-0795
Practice Address - Fax:770-607-1339
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics