Healthcare Provider Details

I. General information

NPI: 1801420146
Provider Name (Legal Business Name): SCOTT HANSEN LOWRY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

3320 TOBIN ST
AUGUSTA GA
30906-4935
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2371
  • Fax:
Mailing address:
  • Phone: 706-255-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN016103
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: