Provider Demographics
NPI:1194168161
Name:OWENS, ANDREW VENTERS (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:VENTERS
Last Name:OWENS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:131 MEDICAL PARK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8525
Mailing Address - Country:US
Mailing Address - Phone:704-660-4524
Mailing Address - Fax:704-660-4106
Practice Address - Street 1:218 OLD MOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1930
Practice Address - Country:US
Practice Address - Phone:704-838-7457
Practice Address - Fax:704-838-7435
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2018-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2017-021792084P0800X
GA746802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194168161Medicaid