Provider Demographics
NPI:1841302502
Name:ATLANTA CENTER FOR UROLOGY RESEARCH & DEVELOPMENT PC
Entity type:Organization
Organization Name:ATLANTA CENTER FOR UROLOGY RESEARCH & DEVELOPMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
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:CEDAR COTTAGE, SUITE C-100
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-5286
Mailing Address - Country:US
Mailing Address - Phone:706-454-0100
Mailing Address - Fax:706-454-0101
Practice Address - Street 1:1000 COWLES CLINC WAY
Practice Address - Street 2:CEDAR COTTAGE, SUITE C-100
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5285
Practice Address - Country:US
Practice Address - Phone:706-454-0100
Practice Address - Fax:706-454-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00309603EMedicaid
GA003096003BMedicaid