Healthcare Provider Details

I. General information

NPI: 1861673808
Provider Name (Legal Business Name): EMMETT W BOWERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST SGMC
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

2310 N PATTERSON ST SUITE C
VALDOSTA GA
31602-2568
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-6852
  • Fax: 229-242-2385
Mailing address:
  • Phone: 229-244-6852
  • Fax: 229-242-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number65641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: