Healthcare Provider Details

I. General information

NPI: 1285644211
Provider Name (Legal Business Name): JOSIE B BOWEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHARON AMITY RD STE 300
CHARLOTTE NC
28211-0035
US

IV. Provider business mailing address

501 S SHARON AMITY RD STE 300
CHARLOTTE NC
28211-0035
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-2424
  • Fax: 704-377-2687
Mailing address:
  • Phone: 704-377-2424
  • Fax: 704-377-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200400192
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: