Healthcare Provider Details

I. General information

NPI: 1417979550
Provider Name (Legal Business Name): BOWMAN PAIN MANAGEMENT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 LAKESIDE COMMONS DR SUITE A
MACON GA
31210-5779
US

IV. Provider business mailing address

6010 LAKESIDE COMMONS DR SUITE A
MACON GA
31210-5779
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-9220
  • Fax: 478-475-9201
Mailing address:
  • Phone: 478-475-9220
  • Fax: 478-475-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DWAYNE L CLAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 478-475-9220