Provider Demographics
NPI:1538375043
Name:DEAN, NEELY BOWDEN (MD)
Entity type:Individual
Prefix:DR
First Name:NEELY
Middle Name:BOWDEN
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9027
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9027
Mailing Address - Country:US
Mailing Address - Phone:706-324-4891
Mailing Address - Fax:706-576-4958
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE B001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6808
Practice Address - Country:US
Practice Address - Phone:706-324-4891
Practice Address - Fax:706-576-4958
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059401207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA214166623HMedicaid
GA202I160860OtherMEDICARE PTAN
GA059401OtherGEORGIA MEDICAL LICENSE