Provider Demographics
NPI:1013582287
Name:LOWERY, BRENDA J (OWNER, MA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:LOWERY
Suffix:
Gender:F
Credentials:OWNER, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6961 MAHONIA PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4588
Mailing Address - Country:US
Mailing Address - Phone:770-866-7815
Mailing Address - Fax:
Practice Address - Street 1:6961 MAHONIA PL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4588
Practice Address - Country:US
Practice Address - Phone:770-866-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7KQ9Medicaid