Provider Demographics
NPI:1043248750
Name:BOWERS, TERRA MCDONALD (PA)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:MCDONALD
Last Name:BOWERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 HEMBREE RD
Practice Address - Street 2:STE. 210
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1122
Practice Address - Country:US
Practice Address - Phone:770-740-1753
Practice Address - Fax:770-740-8503
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2719363A00000X
GA002719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002719OtherLICENCE