Provider Demographics
NPI:1770915191
Name:COWGILL, BRYCE SIMPSON (AGACNP)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:SIMPSON
Last Name:COWGILL
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2665 N DECATUR RD STE 430
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6145
Mailing Address - Country:US
Mailing Address - Phone:404-294-4018
Mailing Address - Fax:404-294-9161
Practice Address - Street 1:6335 HOSPITAL PKWY STE 307
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5712
Practice Address - Country:US
Practice Address - Phone:678-474-9277
Practice Address - Fax:678-475-2751
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181784363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137375AMedicaid
GA003137375AMedicaid