Provider Demographics
NPI:1326601600
Name:BOWERS, JACOB STUART (MD PHD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:STUART
Last Name:BOWERS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9328
Mailing Address - Country:US
Mailing Address - Phone:801-573-7771
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-4220
Practice Address - Country:US
Practice Address - Phone:706-721-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA132852085R0204X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology