MEDICARE: RICHARD TYLER COWART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	8093	GA

General Provider Information

NPI Number	:	1568862381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD TYLER COWART MD

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7211
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 200
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0824
Country	:	US
Telephone Number	:	912-871-7100
Fax Number	:	912-871-7110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/20/2021

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