Provider Demographics
NPI:1881751873
Name:BOWER, SUSAN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:BOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 MEDLOCK BRIDGE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4446
Mailing Address - Country:US
Mailing Address - Phone:770-338-6558
Mailing Address - Fax:770-232-1326
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4446
Practice Address - Country:US
Practice Address - Phone:770-338-6558
Practice Address - Fax:770-232-1326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0403222084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040322OtherMEDICAL LICENSE NUMBER
GA040322OtherMEDICAL LICENSE NUMBER
GABB4523583OtherDEA NUMBER
GABB4523583OtherDEA NUMBER
GAF75432Medicare UPIN
GA26BDFSBMedicare ID - Type Unspecified