Healthcare Provider Details

I. General information

NPI: 1790444636
Provider Name (Legal Business Name): EBONY BOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 SCRUGGS LN APT 1019
NASHVILLE TN
37207-2629
US

IV. Provider business mailing address

5515 SCRUGGS LN APT 1019
NASHVILLE TN
37207-2629
US

V. Phone/Fax

Practice location:
  • Phone: 615-497-2935
  • Fax:
Mailing address:
  • Phone: 615-497-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: