Doctor Name: | MRS. MELANIE GRACE BOWEN |
NPI Number: | 1003984915 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 004613 |
Business Practice Address: | 2922 Professional Pkwy Augusta, GA - 309076528 |
Business Phone Number: | 7065562767 |
Business Fax Number: | |
Mailing Address: | 4654 Clifden Ave, GROVETOWN |
State: | GA |
Postal Code: | 308135238 |
Phone Number: | 7063397864 |
Fax Number: | |
NPI Enumeration Date: | 11/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004613 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |