Provider Demographics
NPI:1538116827
Name:GOWDER, GEORGE DAVID III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DAVID
Last Name:GOWDER
Suffix:III
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 1:214 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3102
Mailing Address - Country:US
Mailing Address - Phone:706-745-2111
Mailing Address - Fax:
Practice Address - Street 1:214 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3102
Practice Address - Country:US
Practice Address - Phone:706-745-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025163207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29604Medicare UPIN