1326230533 NPI number — DR. KATIE LARYN COWAN PSY.D.

Table of content: DR. KATIE LARYN COWAN PSY.D. (NPI 1326230533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326230533 NPI number — DR. KATIE LARYN COWAN PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWAN
Provider First Name:
KATIE
Provider Middle Name:
LARYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARCLAY
Provider Other First Name:
KATIE
Provider Other Middle Name:
LARYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326230533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 GRANITE COVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30642-7000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-931-6555
Provider Business Mailing Address Fax Number:
404-393-9635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 HARMONY RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
EATONTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31024-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-931-6555
Provider Business Practice Location Address Fax Number:
404-393-9635
Provider Enumeration Date:
08/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  003177 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003106637A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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