Provider Demographics
NPI:1780735944
Name:COBB PEDIATRICS, PC
Entity type:Organization
Organization Name:COBB PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEBISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-504-1199
Mailing Address - Street 1:410 VILLA RICA WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064
Mailing Address - Country:US
Mailing Address - Phone:678-504-1199
Mailing Address - Fax:678-504-1175
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:BLDG. 2, STE.D
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127
Practice Address - Country:US
Practice Address - Phone:770-425-5331
Practice Address - Fax:770-425-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty