Provider Demographics
NPI:1326142456
Name:COWAN, JOHN A SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:COWAN
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:SUITE 104; CARTERSVILLE MEDICAL ARTS CENTER
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120
Mailing Address - Country:US
Mailing Address - Phone:770-386-0090
Mailing Address - Fax:770-387-9126
Practice Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 104; CARTERSVILLE MEDICAL ARTS CENTER
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-386-0090
Practice Address - Fax:770-387-9126
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-11-28
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Provider Licenses
StateLicense IDTaxonomies
GA15363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000416061BMedicaid
GA000416061BMedicaid