Provider Demographics
NPI:1053985341
Name:COBB REGENERATIVE & JOINT CLINIC LLC
Entity type:Organization
Organization Name:COBB REGENERATIVE & JOINT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIXTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-485-8298
Mailing Address - Street 1:1050 SHILOH RD NW STE 305
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-8100
Mailing Address - Country:US
Mailing Address - Phone:770-485-8298
Mailing Address - Fax:770-234-5215
Practice Address - Street 1:1050 SHILOH RD NW STE 305
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-8100
Practice Address - Country:US
Practice Address - Phone:770-485-8298
Practice Address - Fax:770-234-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty