Provider Demographics
NPI:1982274254
Name:COBB, CALLIE ANN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANN ELIZABETH
Last Name:COBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 PROVIDENCE TRL APT 10102
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6563
Mailing Address - Country:US
Mailing Address - Phone:606-627-9831
Mailing Address - Fax:
Practice Address - Street 1:1156 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3110
Practice Address - Country:US
Practice Address - Phone:615-989-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN5231363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant