Provider Demographics
NPI:1730858432
Name:COBBS, YVETTE
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:COBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29437-2806
Mailing Address - Country:US
Mailing Address - Phone:843-539-9570
Mailing Address - Fax:
Practice Address - Street 1:8887 OLD UNIVERSITY BLVD STE 200-3
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7123
Practice Address - Country:US
Practice Address - Phone:843-539-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC863358366Medicaid