Healthcare Provider Details

I. General information

NPI: 1912094020
Provider Name (Legal Business Name): RONALD COWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE STE 200
MEMPHIS TN
38103-3434
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-2400
  • Fax: 901-302-2420
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD34782
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: