Provider Demographics
NPI:1992881734
Name:NORMAN F. MCGOWIN III MD PC
Entity type:Organization
Organization Name:NORMAN F. MCGOWIN III MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGOWIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:334-382-6864
Mailing Address - Street 1:P.O. BOX 398
Mailing Address - Street 2:45 MEDICAL ARTS COURT, SUITE 4
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36015-0398
Mailing Address - Country:US
Mailing Address - Phone:334-382-6864
Mailing Address - Fax:334-382-6929
Practice Address - Street 1:45 MEDICAL ARTS COURT, SUITE 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-0398
Practice Address - Country:US
Practice Address - Phone:334-382-6864
Practice Address - Fax:334-382-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7855207R00000X
AL00009886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529701640Medicaid
ALH127Medicare PIN
ALCN3137Medicare PIN