Provider Demographics
NPI:1134566789
Name:BOWERS, ROBERT L (DO, PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MILSTEAD RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3835
Mailing Address - Country:US
Mailing Address - Phone:404-251-2544
Mailing Address - Fax:770-761-6849
Practice Address - Street 1:1567 MILSTEAD RD NE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:404-251-2544
Practice Address - Fax:770-761-6849
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077709208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty