Provider Demographics
NPI:1316600067
Name:COWRY KIDNEY CARE LLC
Entity Type:Organization
Organization Name:COWRY KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:NWEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-227-8130
Mailing Address - Street 1:1720 MARS HILL RD NW STE 120-380
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7127
Mailing Address - Country:US
Mailing Address - Phone:470-227-8130
Mailing Address - Fax:470-747-7588
Practice Address - Street 1:8570 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2413
Practice Address - Country:US
Practice Address - Phone:470-227-8130
Practice Address - Fax:470-747-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty