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Organization
BULLOCH FAMILY PRACTICE
Active
Organization
BULLOCH FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOY D COWART III MD (OWNER)
(912) 259-9633
Entity
Organization
Contact information
Practice address
112 HILL POND LN, STATESBORO, GA 30458-0872
(912) 259-9633
Mailing address
911 MONARCH CIR, STATESBORO, GA 30458-9197
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/26/2023
Last updated
11/20/2023
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