Provider Demographics
NPI:1710984414
Name:LOWERY, PATRICIA A (NDT CRTT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:LOWERY
Suffix:
Gender:F
Credentials:NDT CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115D HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3555
Mailing Address - Country:US
Mailing Address - Phone:478-274-1653
Mailing Address - Fax:478-274-0895
Practice Address - Street 1:1115D HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3555
Practice Address - Country:US
Practice Address - Phone:478-274-1653
Practice Address - Fax:478-274-0895
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004224227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00868447AMedicaid
GA00868447AMedicaid