Provider Demographics
NPI:1982684783
Name:CHERAW PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:CHERAW PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COBBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-537-5112
Mailing Address - Street 1:721 SOUTH DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520
Mailing Address - Country:US
Mailing Address - Phone:843-537-5112
Mailing Address - Fax:843-537-1163
Practice Address - Street 1:721 SOUTH DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520
Practice Address - Country:US
Practice Address - Phone:843-537-5112
Practice Address - Fax:843-537-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC185971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC185971Medicaid
SC185971Medicaid