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General NPI Number Information
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NPI Number | 1740365691
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Entity Type | Individual
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Provider Name | GEORGE LANGSTROTH COWAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 523 S DARGAN ST
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City | FLORENCE
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State | SC
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Zip | 29506-2549
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Country | US
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Telephone | 843-503-1235
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Fax | 843-389-2372
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Provider Business Mailing Address
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Address Line | 680 BORKOWITZ RD
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City | SCRANTON
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State | SC
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Zip | 29591-5188
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Country | US
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Telephone | 843-610-5727
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Fax |
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 29697
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 29697
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License Number State | SC
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