Provider Demographics
NPI:1669550034
Name:GOWDY, SHEILA ANN (OD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:GOWDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135
Mailing Address - Country:US
Mailing Address - Phone:770-920-9144
Mailing Address - Fax:770-987-6828
Practice Address - Street 1:9412 PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:770-920-9144
Practice Address - Fax:770-987-6828
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001760152W00000X
NY006074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist