Active NPI
Gary Anthony Rudolph Bowen, PA-C
- Physician Assistant
- Decatur, GA
National Provider Identifier
1265849343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 7262
- Practice address
- 1014 Sycamore Dr
Suite B
Decatur, GA 30030-1644 - Phone
- (404) 480-4229
- NPI assigned
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 7262 | GA | Primary |
Addresses
Primary practice location
1014 Sycamore Dr
Suite B
Decatur, GA 30030-1644
Mailing address
825 Common Oak PL
Lawrenceville, GA 30045-8256
Phone (210) 781-3997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7262 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1265849343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 COMMON OAK PL",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458256",
"telephone_number": "210-781-3997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1014 SYCAMORE DR",
"address_2": "SUITE B",
"city": "DECATUR",
"state": "GA",
"postal_code": "300301644",
"telephone_number": "404-480-4229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOWEN",
"first_name": "GARY",
"middle_name": "ANTHONY RUDOLPH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-21",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "7262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.