Provider Demographics
NPI:1508477613
Name:DOWDA, JAN WOOD (RPH)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:WOOD
Last Name:DOWDA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-2025
Mailing Address - Country:US
Mailing Address - Phone:770-893-8681
Mailing Address - Fax:
Practice Address - Street 1:192 1ST ST
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-635-2241
Practice Address - Fax:706-635-2246
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071888183500000X
GARPH017888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist