Healthcare Provider Details

I. General information

NPI: 1326677618
Provider Name (Legal Business Name): CLAY COSTON ROWE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW STE 250
MARIETTA GA
30060-1162
US

IV. Provider business mailing address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-2020
  • Fax: 770-999-2785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95886
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: