Provider Demographics
NPI:1205196235
Name:BOWMAN, DEBORAH GOODEN ADAMS (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GOODEN ADAMS
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1161 SHERRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5341
Mailing Address - Country:US
Mailing Address - Phone:404-552-1805
Mailing Address - Fax:770-613-0196
Practice Address - Street 1:5127 JIMMY CARTER BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1619
Practice Address - Country:US
Practice Address - Phone:404-564-7016
Practice Address - Fax:770-368-3846
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1326363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical