Provider Demographics
NPI:1548232473
Name:BOWEN, MARK T (NP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:BOWEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 SEAWRIGHT DR STE 108
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2752
Mailing Address - Country:US
Mailing Address - Phone:912-350-5940
Mailing Address - Fax:912-350-5991
Practice Address - Street 1:6510 SEAWRIGHT DR STE 108
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-350-5940
Practice Address - Fax:912-350-5991
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA563072249GMedicaid
582162071-028OtherHUMANA/TRICARE SOUTH
GA563072249AMedicaid
GA563072249BMedicaid
GAP00358208OtherRAILROAD MEDICARE
SCNP1303Medicaid
SCNP1303Medicaid
GA563072249AMedicaid