Healthcare Provider Details

I. General information

NPI: 1366484255
Provider Name (Legal Business Name): JAMES FURMAN GOWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD SUITE 190
BRUNSWICK GA
31520-4788
US

IV. Provider business mailing address

3025 SHRINE RD SUITE 190
BRUNSWICK GA
31520-4788
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7250
  • Fax: 912-466-7253
Mailing address:
  • Phone: 912-466-7250
  • Fax: 912-466-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: