Healthcare Provider Details

I. General information

NPI: 1912921065
Provider Name (Legal Business Name): LOY D COWART III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/19/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOCTORS ST
METTER GA
30439-3337
US

IV. Provider business mailing address

200 N RIVER ST
CLAXTON GA
30417-1659
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-5715
  • Fax:
Mailing address:
  • Phone: 912-739-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: