Provider Demographics
NPI:1740454099
Name:WEST COBB MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:WEST COBB MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-398-8301
Mailing Address - Street 1:870 CRESTMARK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2665
Mailing Address - Country:US
Mailing Address - Phone:678-398-8301
Mailing Address - Fax:678-398-8305
Practice Address - Street 1:870 CRESTMARK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2665
Practice Address - Country:US
Practice Address - Phone:678-398-8301
Practice Address - Fax:678-398-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7204Medicare PIN