Provider Demographics
NPI:1114707080
Name:BOWMAN, JILLIAN MARIE (LDO)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:MARIE
Other - Last Name:NAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDOA
Mailing Address - Street 1:1455 HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-7607
Mailing Address - Country:US
Mailing Address - Phone:706-782-6961
Mailing Address - Fax:706-782-6966
Practice Address - Street 1:1455 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-7607
Practice Address - Country:US
Practice Address - Phone:706-782-6961
Practice Address - Fax:706-782-6966
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002861156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician