Provider Demographics
NPI:1518765478
Name:BOWMAN, GUSSIE (RN)
Entity type:Individual
Prefix:
First Name:GUSSIE
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 MUNDYS MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-6026
Mailing Address - Country:US
Mailing Address - Phone:770-702-0323
Mailing Address - Fax:888-712-7702
Practice Address - Street 1:1489 MUNDYS MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-6026
Practice Address - Country:US
Practice Address - Phone:770-702-0323
Practice Address - Fax:888-712-7702
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216819163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator