| Cobb Medical Clinic | |
|
2615 E West Connector Ste 106 Austell GA 30106-6848 | |
| (770) 941-0010 | |
| (770) 941-0154 |
| Full Name | Cobb Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2615 E West Connector Ste 106, Austell, Georgia |
| Authorized Official Name and Position | Chandresh B Shah (OWNER) |
| Authorized Official Contact | 7709410010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cobb Medical Clinic 2615 E West Connector Ste 106 Austell GA 30106-6848 Ph: (770) 941-0010 | Cobb Medical Clinic 2615 E West Connector Ste 106 Austell GA 30106-6848 Ph: (770) 941-0010 |
| NPI Number | 1922553023 |
|---|---|
| Provider Enumeration Date | 08/18/2016 |
| Last Update Date | 01/20/2022 |
| Medicare PECOS PAC ID | 8628491602 |
|---|---|
| Medicare Enrollment ID | O20200709000915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922553023 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038955 (Georgia) | Primary |
| Provider Name | Chandresh B Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770655987 PECOS PAC ID: 0941278592 Enrollment ID: I20040921000900 |
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