Provider Demographics
NPI:1407237266
Name:COWELL, GEORGE III
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:COWELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 PIMLICO PARK
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8020
Mailing Address - Country:US
Mailing Address - Phone:567-742-2223
Mailing Address - Fax:
Practice Address - Street 1:1105 PIMLICO PARK
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8020
Practice Address - Country:US
Practice Address - Phone:567-742-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR754762171W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171W00000XOther Service ProvidersContractor