Provider Demographics
NPI:1205820685
Name:BOWERS, JEMISON O (MD)
Entity Type:Individual
Prefix:
First Name:JEMISON
Middle Name:O
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 1:979 E 3RD ST
Mailing Address - Street 2:STE B-1001
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-648-9808
Mailing Address - Fax:423-648-4570
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:BOX 338
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-648-9808
Practice Address - Fax:423-648-4570
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD06572207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3149612Medicaid
TN3149612Medicare ID - Type Unspecified
TN3149612Medicaid