Provider Demographics
NPI:1982789293
Name:BOWEN, CINDY JO-ANN (NP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:JO-ANN
Last Name:BOWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 BAFFIN RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1790
Mailing Address - Country:US
Mailing Address - Phone:678-933-5381
Mailing Address - Fax:
Practice Address - Street 1:2612 MAX CLELAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4400
Practice Address - Country:US
Practice Address - Phone:678-526-5429
Practice Address - Fax:678-526-5434
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner