Provider Demographics
NPI:1538896626
Name:BOWMAN, COURTNEY S (IBCLC)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:S
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2507
Mailing Address - Country:US
Mailing Address - Phone:678-499-0711
Mailing Address - Fax:
Practice Address - Street 1:3726 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2507
Practice Address - Country:US
Practice Address - Phone:678-499-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111659852369Medicaid