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NPI Code Detail

MEDICARE: LARRY D JOWERS PA-C

MEDICARE: LARRY D JOWERS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant004316GA

General Provider Information

NPI Number : 1548274954
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY D JOWERS PA-C
Provider Business Mailing Address
First Line : 1120 15TH ST STE BI1056
Second Line :
City : AUGUSTA
State : GA
Zip : 30912-0004
Country : US
Telephone Number : 706-721-3813
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W WHEELER PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6625
Country : US
Telephone Number : 706-869-1515
Fax Number : 706-721-1459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 01/04/2019

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