Provider Demographics
NPI:1518183987
Name:BOWLING, SCOTT W (PA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:BOWLING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE SUITE 1D03 WINN ARMY COMMUNITY HOSPITA
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:31314-5674
Mailing Address - Country:US
Mailing Address - Phone:912-435-6022
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:WINN ARMY COMMUNITY HOSPITAL SUITE 1D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5674
Practice Address - Country:US
Practice Address - Phone:912-435-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GATL1533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA791906472AMedicaid
GA01155297OtherAMERIGROUP
GA791906472Medicaid
GA791906472BMedicaid
GA791906472CMedicaid
GA791906472DMedicaid
GA97WCJQLMedicare PIN
GA01155297OtherAMERIGROUP
GAQ79069Medicare UPIN