Provider Demographics
NPI:1760685978
Name:ROWE, TONY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:L
Last Name:ROWE
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 1:1427 MARY ANN AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4162
Mailing Address - Country:US
Mailing Address - Phone:229-386-4390
Mailing Address - Fax:
Practice Address - Street 1:202 S MADISON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5479
Practice Address - Country:US
Practice Address - Phone:229-226-1035
Practice Address - Fax:229-226-3378
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58636207L00000X, 332B00000X
FLME 97400207L00000X
TNMD 41611207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA926689958AMedicaid
GA926689958AMedicaid