Provider Demographics
NPI:1245331354
Name:MCGOWAN, MARY HOLCOMBE (MS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HOLCOMBE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:HOLCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:5356 REYNOLDS ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6106
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 505
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6106
Practice Address - Country:US
Practice Address - Phone:912-644-5300
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA721039439IMedicaid
GA721039439IMedicaid
GA721039439BMedicaid
SCSAG 019Medicaid
Q32304Medicare UPIN
GA64BCBMTMedicare ID - Type Unspecified