Provider Demographics
NPI:1669468054
Name:COWLES CLINIC SERVICES, LLC
Entity Type:Organization
Organization Name:COWLES CLINIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWLES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:706-454-0100
Mailing Address - Street 1:1000 COWLES CLINC WAY
Mailing Address - Street 2:ASPEN COTTAGE, SUITE A-400
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5285
Mailing Address - Country:US
Mailing Address - Phone:706-454-0025
Mailing Address - Fax:
Practice Address - Street 1:1000 COWLES CLINC WAY
Practice Address - Street 2:ASPEN COTTAGE, SUITE A-400
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5285
Practice Address - Country:US
Practice Address - Phone:706-454-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAY19707Medicare UPIN
GA69WBDMRMedicare ID - Type UnspecifiedPROVIDER NUMBER