MEDICARE: MISS JACQUELINE NAN BOWDEN CNIM

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
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1629502422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JACQUELINE NAN BOWDEN CNIM

Provider Business Mailing Address
First Line	:	6215 EASTLAND CT SE
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-8853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3284 NORTHSIDE PKWY NW
Second Line	:	SUITE 600
City	:	ATLANTA
State	:	GA
Zip	:	30327-2280
Country	:	US
Telephone Number	:	866-782-1184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	04/18/2017

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