Provider Demographics
NPI:1104063882
Name:STOWERS, JEFFERSON WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:WAYNE
Last Name:STOWERS
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 1:400 MCDANIEL RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1830
Mailing Address - Country:US
Mailing Address - Phone:770-425-8307
Mailing Address - Fax:
Practice Address - Street 1:400 MCDANIEL RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1830
Practice Address - Country:US
Practice Address - Phone:770-425-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist