Provider Demographics
NPI:1154511426
Name:BOWDRE, YOLANDA P (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:P
Last Name:BOWDRE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3752 PRESERVATION CIR
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7063
Mailing Address - Country:US
Mailing Address - Phone:770-866-1794
Mailing Address - Fax:
Practice Address - Street 1:3752 PRESERVATION CIR
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-7063
Practice Address - Country:US
Practice Address - Phone:770-866-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003373174400000X
GAOT003773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist