Provider Demographics
NPI:1962645382
Name:OWENS, TIMOTHY RYAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RYAN
Last Name:OWENS
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 1213
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1213
Mailing Address - Country:US
Mailing Address - Phone:912-466-5000
Mailing Address - Fax:912-466-5013
Practice Address - Street 1:2500 STARLING ST STE 403
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4269
Practice Address - Country:US
Practice Address - Phone:912-466-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73589207T00000X, 193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No193400000XGroupSingle Specialty