Healthcare Provider Details

I. General information

NPI: 1770575789
Provider Name (Legal Business Name): MICHAEL GENE BOWMAN LPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

IV. Provider business mailing address

DEPARTMENT 888182
KNOXVILLE TN
37995-0001
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-7337
  • Fax: 423-586-0614
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPE1422
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: