Provider Demographics
NPI:1992193460
Name:GEORGE COWAN JR.
Entity Type:Organization
Organization Name:GEORGE COWAN JR.
Other - Org Name:UNIVERSITY OF TENNESSEE MEMPHIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-274-1336
Mailing Address - Street 1:1835 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5010
Mailing Address - Country:US
Mailing Address - Phone:901-274-1336
Mailing Address - Fax:
Practice Address - Street 1:1835 FORREST AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-5010
Practice Address - Country:US
Practice Address - Phone:901-274-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14461251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable