Healthcare Provider Details

I. General information

NPI: 1003190117
Provider Name (Legal Business Name): INPATIENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 FAIRVIEW RD
MOORESVILLE NC
28117-9500
US

IV. Provider business mailing address

PO BOX 6009
ATHENS GA
30604-6009
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-4166
  • Fax:
Mailing address:
  • Phone: 704-660-4166
  • Fax: 704-660-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN COWAN
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 704-660-4166