Provider Demographics
NPI:1770103186
Name:OWENS, JOSEPH BRET (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRET
Last Name:OWENS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LOGGING HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6841
Mailing Address - Country:US
Mailing Address - Phone:407-456-2031
Mailing Address - Fax:
Practice Address - Street 1:11258 FORD AVE STE 13
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8880
Practice Address - Country:US
Practice Address - Phone:407-456-2031
Practice Address - Fax:912-514-0045
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98691207R00000X, 208D00000X
GA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care