Provider Demographics
NPI:1215026646
Name:BOWIE, BRETT ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ASHLEY
Last Name:BOWIE
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 1:303 MEDICAL DR STE 405
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4145
Mailing Address - Country:US
Mailing Address - Phone:706-242-5099
Mailing Address - Fax:706-242-5231
Practice Address - Street 1:303 MEDICAL DR STE 405
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4145
Practice Address - Country:US
Practice Address - Phone:706-242-5099
Practice Address - Fax:706-242-5231
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054552207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111599922AMedicaid
16BBCJCMedicare ID - Type Unspecified
GA111599922AMedicaid