Provider Demographics
NPI:1861180994
Name:BOWLIN, GEORGIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILDWOOD CT APT 322
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2800
Mailing Address - Country:US
Mailing Address - Phone:601-757-9299
Mailing Address - Fax:
Practice Address - Street 1:1424 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2208
Practice Address - Country:US
Practice Address - Phone:205-578-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist