Provider Demographics
NPI:1245270321
Name:BOWERS, WILLIE R (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:R
Last Name:BOWERS
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 1:5 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3345
Mailing Address - Country:US
Mailing Address - Phone:912-355-2400
Mailing Address - Fax:912-355-5324
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042188207P00000X
SC27532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000716702CMedicaid
GA10058570OtherAMERIGROUP
GA000716702IMedicaid
GA000716702Medicaid
GA000716702BMedicaid
GA000716702JMedicaid
GA000716702EMedicaid
SCG42188Medicaid
GA000716702AMedicaid
SC000716702HMedicaid
GAP00398968Medicare PIN
SCG343998055Medicare PIN
GA93BDNHSMedicare PIN
GA93BBDJWKMedicare PIN
GA000716702Medicaid
GA930041041Medicare PIN
GA10058570OtherAMERIGROUP
G34399Medicare UPIN
GA000716702IMedicaid
GA000716702JMedicaid