| Cobb County Community Services Board | |
|
3830 S Cobb Dr Se Suite 300 Smyrna GA 30080-5532 | |
| (770) 429-5000 | |
| Not Available |
| Full Name | Cobb County Community Services Board |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3830 S Cobb Dr Se, Smyrna, Georgia |
| Authorized Official Name and Position | Tod Citron (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7704295000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cobb County Community Services Board 3830 S Cobb Dr Se Suite 300 Smyrna GA 30080-5532 Ph: (770) 429-5000 | Cobb County Community Services Board 3830 S Cobb Dr Se Suite 300 Smyrna GA 30080-5532 Ph: (770) 429-5000 |
| NPI Number | 1750442331 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 01/19/2021 |
| Certification Date | 01/19/2021 |
| Medicare PECOS PAC ID | 7719875566 |
|---|---|
| Medicare Enrollment ID | O20040304001136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750442331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Deborah L Bryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104975648 PECOS PAC ID: 5193779726 Enrollment ID: I20050308000316 |
| Provider Name | Cynthia B Mcneill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891294633 PECOS PAC ID: 9931528965 Enrollment ID: I20200924002047 |
| Provider Name | Bunmi Ogungbeje |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386065027 PECOS PAC ID: 3476967472 Enrollment ID: I20210203001290 |
| Provider Name | Pagrita Fuller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215462718 PECOS PAC ID: 0941615462 Enrollment ID: I20210216000869 |
| Provider Name | Asha G Pandya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477632735 PECOS PAC ID: 3173937075 Enrollment ID: I20210219001205 |
| Provider Name | Beatrice Nduwimana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962010975 PECOS PAC ID: 5799185930 Enrollment ID: I20210610000524 |
| Provider Name | Ifeoma Osijo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831735513 PECOS PAC ID: 6507269321 Enrollment ID: I20210730000666 |
| Provider Name | Mir A Wadud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801164389 PECOS PAC ID: 9830366277 Enrollment ID: I20210818002744 |
| Provider Name | Pristella O Ohanaja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073967055 PECOS PAC ID: 3072802933 Enrollment ID: I20210831000062 |
| Provider Name | Domonic Jovan Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962821033 PECOS PAC ID: 1254636327 Enrollment ID: I20210916001418 |
| Provider Name | Angela Danforth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003312257 PECOS PAC ID: 2769872597 Enrollment ID: I20211209000688 |
| Provider Name | Danielle L Stembridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023689049 PECOS PAC ID: 3072904499 Enrollment ID: I20211220000830 |
| Provider Name | Marcia Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568907822 PECOS PAC ID: 0244624369 Enrollment ID: I20220304002025 |
| Provider Name | Blanche H Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992478903 PECOS PAC ID: 4082008032 Enrollment ID: I20220308002079 |
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