Healthcare Provider Details

I. General information

NPI: 1104040229
Provider Name (Legal Business Name): BOWDEN INTERNAL MEDICINE,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 MADISON AVE
MEMPHIS TN
38104-2508
US

IV. Provider business mailing address

1652 MADISON AVE
MEMPHIS TN
38104-2508
US

V. Phone/Fax

Practice location:
  • Phone: 901-278-9538
  • Fax: 901-726-9883
Mailing address:
  • Phone: 901-278-9538
  • Fax: 901-726-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: MARCIA R BOWDEN
Title or Position: OWNER
Credential: MD
Phone: 901-278-9538