Provider Demographics
NPI:1871609735
Name:THE COBB FOUNDATION, INC.
Entity type:Organization
Organization Name:THE COBB FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATRO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-856-6113
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-0280
Mailing Address - Country:US
Mailing Address - Phone:706-856-6100
Mailing Address - Fax:706-856-6117
Practice Address - Street 1:138 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1847
Practice Address - Country:US
Practice Address - Phone:706-856-6100
Practice Address - Fax:706-856-6294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COBB FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073-494275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000921SMedicaid
GA11U059Medicare ID - Type Unspecified