Healthcare Provider Details

I. General information

NPI: 1578874277
Provider Name (Legal Business Name): JOHN MICHAEL GOWDY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4111
  • Fax: 864-725-4798
Mailing address:
  • Phone: 864-725-4111
  • Fax: 864-725-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number82203
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102209092
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number109820
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOP60630438
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number109820
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: