Healthcare Provider Details

I. General information

NPI: 1033140827
Provider Name (Legal Business Name): SHARON COWAN CAC MAC LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LANIER RD
MADISON AL
35758
US

IV. Provider business mailing address

2868 ACTON RD
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 256-774-4586
  • Fax: 256-774-4580
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1494G
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1067
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number502105
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: