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General NPI Number Information
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NPI Number | 1730688490
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Entity Type | Organization
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Legal Business Name | COWRY MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 10/22/2023
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Provider Practice Location Address
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Address Line | 4450 CALIBRE XING NW STE 1126
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City | ACWORTH
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State | GA
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Zip | 30101-4104
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Country | US
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Telephone | 470-227-8130
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Fax | 470-747-7588
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Provider Business Mailing Address
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Address Line | 1720 MARS HILL RD NW STE 120-380
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City | ACWORTH
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State | GA
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Zip | 30101-7127
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Country | US
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Telephone | 470-227-8130
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Fax | 470-747-7588
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Authorized Official
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Title or Position | CEO
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Name | DR. CHINEDU NWEKE
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Credential | MD
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Telephone | 470-227-8130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 78384
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License Number State | GA
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