MEDICARE: COWLES CLINIC SERVICES, LLC

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1831103696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COWLES CLINIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	1000 COWLES CLINC WAY
Second Line	:	SUITE A-400
City	:	GREENSBORO
State	:	GA
Zip	:	30642-5285
Country	:	US
Telephone Number	:	706-454-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 COWLES CLINC WAY
Second Line	:	SUITE P-100
City	:	GREENSBORO
State	:	GA
Zip	:	30642-5285
Country	:	US
Telephone Number	:	706-454-0036
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRUCE KIRBY
Credential	:
Telephone Number	:	706-454-0027

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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