Provider Demographics
NPI:1720017692
Name:BOWLING, CARRIE P (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:P
Last Name:BOWLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2567
Mailing Address - Country:US
Mailing Address - Phone:229-244-1400
Mailing Address - Fax:
Practice Address - Street 1:2412 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2567
Practice Address - Country:US
Practice Address - Phone:229-244-1400
Practice Address - Fax:229-244-5512
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA584120245AMedicaid
GA584120245FMedicaid
FL292427700Medicaid
GA584120245AMedicaid
GA584120245FMedicaid