Provider Demographics
NPI:1063450427
Name:BOWERS, ELIZABETH MARIA (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIA
Last Name:BOWERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401
Mailing Address - Country:US
Mailing Address - Phone:423-778-9500
Mailing Address - Fax:423-778-8882
Practice Address - Street 1:1751 GUNBARREL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-778-9500
Practice Address - Fax:423-778-8882
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1518207V00000X
GADO052534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA700174OtherBCBS GA
TN3307746Medicaid
TN4062590OtherBCBS TN
GA878005915AMedicaid
GA878005915AMedicaid
GA700174OtherBCBS GA
TN3307746Medicare ID - Type UnspecifiedTN MEDICARE