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General NPI Number Information
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NPI Number | 1568862381
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Entity Type | Individual
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Provider Name | RICHARD TYLER COWART MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 1497 FAIR RD STE 200
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City | STATESBORO
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State | GA
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Zip | 30458-0824
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Country | US
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Telephone | 912-871-7100
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Fax | 912-871-7110
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7211
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Fax | 615-628-6877
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 8093
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License Number State | GA
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