Healthcare Provider Details

I. General information

NPI: 1255398004
Provider Name (Legal Business Name): C BRYCE BOWLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 235
KNOXVILLE TN
37920-1510
US

IV. Provider business mailing address

PO BOX 440439
NASHVILLE TN
37244-0439
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-5940
  • Fax: 865-305-5941
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number38971
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number38971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: