Provider Demographics
NPI:1538965587
Name:BOWEN, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BOWEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 COREY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-6281
Mailing Address - Country:US
Mailing Address - Phone:678-371-2135
Mailing Address - Fax:
Practice Address - Street 1:3236 HIGHWAY 278 NE STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2402
Practice Address - Country:US
Practice Address - Phone:678-371-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty