Provider Demographics
NPI:1790775690
Name:LOWRY, GARNETT MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:GARNETT
Middle Name:MARCUS
Last Name:LOWRY
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:PO BOX 896208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6208
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1026
Practice Address - Street 1:313 TEAL DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2527
Practice Address - Country:US
Practice Address - Phone:910-904-2350
Practice Address - Fax:910-904-1037
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6965764002OtherCIGNA PAL
FH1001465OtherFIRST CAROLINA CARE
NC891303TMedicaid
SCN01231Medicaid
NC1303TOtherBCBS
7248953OtherAETNA
B8019OtherMEDCOST
H57181Medicare UPIN
B8019OtherMEDCOST
NC2298359BMedicare PIN