Provider Demographics
NPI:1912948589
Name:COWAN, AMANDA H (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:H
Last Name:COWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3659
Mailing Address - Country:US
Mailing Address - Phone:912-355-6221
Mailing Address - Fax:
Practice Address - Street 1:361 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3659
Practice Address - Country:US
Practice Address - Phone:912-355-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050793207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA939189478LMedicaid
GA939189478OMedicaid
SCG50793Medicaid
GAP01048154OtherRAILROAD MEDICARE
GA10058684OtherAMERIGROUP
GA939189478MMedicaid
GA939189478GMedicaid
GA939189478NMedicaid
GA939189478PMedicaid
GA939189478QMedicaid
GAP01105586OtherRAILROAD MEDICARE
GA939189478DMedicaid
GA93BBGLPMedicare PIN
GAP00126874Medicare PIN
GA939189478NMedicaid
GA10058684OtherAMERIGROUP
GAP01048154OtherRAILROAD MEDICARE
GAP01105586OtherRAILROAD MEDICARE
SCG50793Medicaid