Provider Demographics
NPI:1083354344
Name:OWENS, ERIC G (RN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:OWENS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 E CREEK MILL CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3058
Mailing Address - Country:US
Mailing Address - Phone:614-316-1338
Mailing Address - Fax:
Practice Address - Street 1:4708 E CREEK MILL CT
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3058
Practice Address - Country:US
Practice Address - Phone:614-316-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH476519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse