Healthcare Provider Details

I. General information

NPI: 1881751873
Provider Name (Legal Business Name): SUSAN LYNN BOWER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 MEDLOCK BRIDGE RD STE 205
JOHNS CREEK GA
30097-4446
US

IV. Provider business mailing address

10475 MEDLOCK BRIDGE RD STE 205
JOHNS CREEK GA
30097-4446
US

V. Phone/Fax

Practice location:
  • Phone: 770-338-6558
  • Fax: 770-232-1326
Mailing address:
  • Phone: 770-338-6558
  • Fax: 770-232-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number040322
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number040322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: