Healthcare Provider Details

I. General information

NPI: 1447488564
Provider Name (Legal Business Name): BRENT ANTHONY CLOWER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11775 POINTE PL SUITE 103
ROSWELL GA
30076-4655
US

IV. Provider business mailing address

11775 POINTE PL SUITE 103
ROSWELL GA
30076-4655
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-7378
  • Fax: 404-341-9979
Mailing address:
  • Phone: 404-500-7378
  • Fax: 404-341-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number69388
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: