Provider Demographics
NPI:1417979550
Name:BOWMAN PAIN MANAGEMENT CENTER, PC
Entity Type:Organization
Organization Name:BOWMAN PAIN MANAGEMENT CENTER, PC
Other - Org Name:BOWMAN PAIN MANAGEMENT, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-475-9220
Mailing Address - Street 1:6010 LAKESIDE COMMONS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5779
Mailing Address - Country:US
Mailing Address - Phone:478-475-9220
Mailing Address - Fax:478-475-9201
Practice Address - Street 1:6010 LAKESIDE COMMONS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5779
Practice Address - Country:US
Practice Address - Phone:478-475-9220
Practice Address - Fax:478-475-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111288ASCAMedicare PIN