Provider Demographics
NPI:1508879057
Name:BOWLING, DONALD W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:BOWLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 LAKEWIND WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6944
Mailing Address - Country:US
Mailing Address - Phone:404-231-5437
Mailing Address - Fax:
Practice Address - Street 1:490 SUN VALLEY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5615
Practice Address - Country:US
Practice Address - Phone:404-231-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00574582AMedicaid
GA68BBCONMedicare ID - Type UnspecifiedMEDICARE
GA00574582AMedicaid