Provider Demographics
NPI:1619389335
Name:BOWERS, JOHN JACOB (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JACOB
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 MEDICAL PLAZA DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9334
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:
Practice Address - Street 1:9300 MEDICAL PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9334
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant