Terry Lamar Cobb
Individual provider Active NPI Contractor · Moultrie, GA
NPI 1184656332 · NPPES record last updated Dec 5, 2007
Key facts
- NPI
- 1184656332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 20017139030 (GA)
- Practice address
- 1321 S Main St
Moultrie, GA 31768-5809 - Phone
- (229) 985-2273
- Fax
- (229) 985-2270
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20017139030 | GA | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Respi-Care, Inc. | Past | Accepting new patients | |
| Bethany Hospice and Palliative Care, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 20017139030 | GA | Yes |
Addresses
Primary practice location
1321 S Main St
Moultrie, GA 31768-5809
Mailing address
1321 S Main St
Moultrie, GA 31768-5809
Phone (229) 985-2273
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52704189001 | Other | GA | BLUE CROSS BLUE SHIELD |
Other providers in Moultrie, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.