Provider Demographics
NPI:1669630133
Name:BOWMAN, BRADLEY REID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:REID
Last Name:BOWMAN
Suffix:
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 1:5221 FOREST VIEW CIR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5947
Mailing Address - Country:US
Mailing Address - Phone:770-941-2152
Mailing Address - Fax:770-732-0899
Practice Address - Street 1:5221 FOREST VIEW CIR SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5947
Practice Address - Country:US
Practice Address - Phone:770-941-2152
Practice Address - Fax:770-732-0899
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FO1645Medicare UPIN