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General NPI Number Information
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NPI Number | 1992193460
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Entity Type | Organization
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Legal Business Name | GEORGE COWAN JR.
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 1835 FORREST AVE
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City | MEMPHIS
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State | TN
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Zip | 38112-5010
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Country | US
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Telephone | 901-274-1336
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 FORREST AVE
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City | MEMPHIS
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State | TN
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Zip | 38112-5010
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Country | US
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Telephone | 901-274-1336
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GEORGE S COWAN
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Credential | M.D.
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Telephone | 901-274-1336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 14461
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License Number State | TN
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