Provider Demographics
NPI:1629643416
Name:BOWENS, ANGELA WILLIAMS
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:WILLIAMS
Last Name:BOWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CERICE CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5533
Mailing Address - Country:US
Mailing Address - Phone:678-357-1831
Mailing Address - Fax:770-405-8382
Practice Address - Street 1:41 CERICE CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-5533
Practice Address - Country:US
Practice Address - Phone:678-357-1831
Practice Address - Fax:770-405-8382
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050937943347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle