Provider Demographics
NPI:1013626134
Name:BOWMAN, SHAWNA YVETTE
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:YVETTE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 ALMOND TREE PL # B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-7058
Mailing Address - Country:US
Mailing Address - Phone:229-251-9305
Mailing Address - Fax:
Practice Address - Street 1:1742 ALMOND TREE PL # B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7058
Practice Address - Country:US
Practice Address - Phone:229-251-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor