Provider Demographics
NPI:1649395369
Name:JEMISON O. BOWERS, MD
Entity Type:Organization
Organization Name:JEMISON O. BOWERS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMISON
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-267-1229
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:BOX 338
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2103
Mailing Address - Country:US
Mailing Address - Phone:423-267-1229
Mailing Address - Fax:423-648-4570
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE B-1001
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-648-9808
Practice Address - Fax:423-648-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3149612Medicaid
3149612Medicare ID - Type Unspecified