Provider Demographics
NPI:1689780835
Name:WEST COBB UROLOGY, PC
Entity Type:Organization
Organization Name:WEST COBB UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-739-2474
Mailing Address - Street 1:1605 MULKEY RD
Mailing Address - Street 2:BLDG 2, SUITE 210
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1127
Mailing Address - Country:US
Mailing Address - Phone:770-739-2474
Mailing Address - Fax:770-944-6357
Practice Address - Street 1:1605 MULKEY RD
Practice Address - Street 2:BLDG 2, SUITE 210
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1127
Practice Address - Country:US
Practice Address - Phone:770-739-2474
Practice Address - Fax:770-944-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29366208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA34BDFHBMedicare PIN