Provider Demographics
NPI:1184927972
Name:GOWDY ENTERPRISES
Entity type:Organization
Organization Name:GOWDY ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:GOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-355-2064
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1404
Mailing Address - Country:US
Mailing Address - Phone:770-355-2064
Mailing Address - Fax:678-615-2224
Practice Address - Street 1:2406 TIFT AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1886
Practice Address - Country:US
Practice Address - Phone:770-355-2064
Practice Address - Fax:229-238-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty