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General NPI Number Information
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NPI Number | 1972649192
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Entity Type | Individual
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Provider Name | GARRY BLAKE BOWDEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2300 W PARK PLACE BLVD 122
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-6713
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Country | US
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Telephone | 770-469-2208
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Fax | 770-469-1558
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Provider Business Mailing Address
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Address Line | PO BOX 769609
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City | ROSWELL
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State | GA
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Zip | 30076-8224
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Country | US
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Telephone | 770-469-2208
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Fax | 770-469-1558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 034545
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License Number State | GA
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