1609976927 NPI number — DR. TAMARA M BOWERS D.O.

Table of content: CLAUDIA KIM ADAMS LPC (NPI 1174802797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609976927 NPI number — DR. TAMARA M BOWERS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWERS
Provider First Name:
TAMARA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWERS
Provider Other First Name:
TAMARA
Provider Other Middle Name:
MCVAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609976927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N PERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48342-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-338-5516
Provider Business Mailing Address Fax Number:
248-338-5547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 N PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-338-5516
Provider Business Practice Location Address Fax Number:
248-338-5547
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  5101015454 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 059128 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 598549056E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01057454 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 598549056B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598549056C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598549056A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598549056G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598549056 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G59128 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598549056D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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