Healthcare Provider Details

I. General information

NPI: 1275538498
Provider Name (Legal Business Name): DAVID T COZART MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S JACKSON HWY STE 203
SHEFFIELD AL
35660-5770
US

IV. Provider business mailing address

1120 S JACKSON HWY STE 203
SHEFFIELD AL
35660-5770
US

V. Phone/Fax

Practice location:
  • Phone: 256-314-6947
  • Fax: 256-314-6902
Mailing address:
  • Phone: 256-314-6947
  • Fax: 256-314-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26645
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: