Provider Demographics
NPI:1124194188
Name:GOWDY, DAVID PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILLIP
Last Name:GOWDY
Suffix:
Gender:M
Credentials:MD
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 1404
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1404
Mailing Address - Country:US
Mailing Address - Phone:770-355-2064
Mailing Address - Fax:
Practice Address - Street 1:101 DEVANT ST
Practice Address - Street 2:SUITE 903 B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2710
Practice Address - Country:US
Practice Address - Phone:770-355-2064
Practice Address - Fax:678-615-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34601207R00000X
GA034601208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69495Medicare UPIN