Provider Demographics
NPI:1093955395
Name:BOWZARD, M. LUISA C (PA)
Entity Type:Individual
Prefix:
First Name:M. LUISA
Middle Name:C
Last Name:BOWZARD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1836 MOUNT BRIAN RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2719
Mailing Address - Country:US
Mailing Address - Phone:678-699-5134
Mailing Address - Fax:404-350-0280
Practice Address - Street 1:275 COLLIER RD NW STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1740
Practice Address - Country:US
Practice Address - Phone:404-350-0009
Practice Address - Fax:404-350-0280
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2021-07-07
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Provider Licenses
StateLicense IDTaxonomies
GA003620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical