Healthcare Provider Details

I. General information

NPI: 1306576525
Provider Name (Legal Business Name): ELISE COWGILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2022
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 WINTON BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

515 55TH PL S
BIRMINGHAM AL
35212-3634
US

V. Phone/Fax

Practice location:
  • Phone: 256-384-8264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: