Provider Demographics
NPI:1659865715
Name:BOWERS, DALE H (APRN)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:H
Last Name:BOWERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BRUCE JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4918
Mailing Address - Country:US
Mailing Address - Phone:770-301-9109
Mailing Address - Fax:
Practice Address - Street 1:241 BRUCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4918
Practice Address - Country:US
Practice Address - Phone:177-030-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner