Provider Demographics
NPI:1912921065
Name:COWART, LOY D III (MD)
Entity Type:Individual
Prefix:DR
First Name:LOY
Middle Name:D
Last Name:COWART
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1659
Mailing Address - Country:US
Mailing Address - Phone:912-739-5000
Mailing Address - Fax:
Practice Address - Street 1:10 DOCTORS ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3337
Practice Address - Country:US
Practice Address - Phone:912-685-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000635225PMedicaid
GA20208I2136Medicare PIN
GAF70652Medicare UPIN