Provider Demographics
NPI:1194856773
Name:BOWERS, GREGORY RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:RICHARD
Last Name:BOWERS
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 1:1510 HATCHER LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4813
Mailing Address - Country:US
Mailing Address - Phone:931-840-4333
Mailing Address - Fax:931-840-0096
Practice Address - Street 1:1510 HATCHER LN
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4813
Practice Address - Country:US
Practice Address - Phone:931-840-4333
Practice Address - Fax:931-840-0096
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD32228208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4027274OtherBLUE CROSS ID
TNA10416Medicare UPIN
TN3848727Medicare ID - Type Unspecified