COBB OUTPATIENT DETOX LLC NPI 1871276105

NPI Information

  • NPI: 1871276105
  • Provider Name: COBB OUTPATIENT DETOX, LLC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • :
  • CLIA Number: 11D2297664
  • Address: 811 LIVINGSTON CT SE STE B
    MARIETTA, GA
    ZIP 30067
  • Phone: (678) 439-6441

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NPI Details

COBB OUTPATIENT DETOX, LLC is a rehabilitation and substance use disorder clinic center in Marietta, GA. COBB OUTPATIENT DETOX, LLC NPI is 1871276105. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

811 LIVINGSTON CT SE STE B
MARIETTA, GA
ZIP 30067-958
Phone: (678) 439-6441
Fax: (470) 857-8728

The provider's authorized official is Gregory Chancy .
The authorized official title is Manager and has the following contact phone number (470) 222-1219.

The CLIA number assigned to this NPI record is 11D2297664 - other - outpatient detox with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2023 and was last updated on 8/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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