NPIMap

Organization Active NPI

Greystone OBGYN PC

Doing business as Greystone OB GYN

  • Specialist
  • Conyers, GA
National Provider Identifier
1790839157
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
038936 Issued in GA
Legal business name
GREYSTONE OBGYN PC
Doing business as
Greystone OB GYN
Practice address
3240 Avalon Boulevard
Conyers, GA 30013-6320
Phone
(770) 860-1133
Fax
(770) 860-1599
NPI assigned
Jan 23, 2007
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Timothy N. Cowthorn, D.O.NPI 1285693374
Title
Physician/Managing Partner
Phone
(770) 860-1133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 038936 GA Primary

Addresses

Primary practice location

3240 Avalon Boulevard
Conyers, GA 30013-6320

Mailing address

3240 Avalon Boulevard
Conyers, GA 30013-6320
Phone (770) 860-1133

Other identifiers 1

IdentifierTypeStateIssuer
00615469EMedicaidGA

Other names 1

  • Greystone OB GYN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041001001062 GA Part B Supplier - Clinic/Group Practice 1153390497 Receives reassigned benefits from 18 practitioners
Practice locations: Conyers, GA; Covington, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0923203Greystone OB/GYN PC3240 Avalon Boulevard, Conyers, GA 30013Certificate of waiverDec 17, 2026

National Provider Directory

National Provider Directory

Locations

3240 Avalon Blvd
Conyers, GA 30013
Phone (770) 860-1133

3307 Salem Rd
Covington, GA 30016
Phone (770) 860-1133

4134 Highway 278 NE
Covington, GA 30014
Phone (770) 788-7447

4143 Hospital Dr NE
Covington, GA 30014
Phone (770) 787-2674

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1790839157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 AVALON BOULEVARD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136320",
            "telephone_number": "770-860-1133",
            "fax_number": "770-860-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 AVALON BOULEVARD",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136320",
            "telephone_number": "770-860-1133",
            "fax_number": "770-860-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREYSTONE OBGYN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "COWTHORN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PHYSICIAN/MANAGING PARTNER",
        "authorized_official_telephone_number": "770-860-1133",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "038936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00615469E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greystone OB GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greystone OB GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.