Provider Demographics
NPI:1194793539
Name:ROGER D OWENS MD PC
Entity type:Organization
Organization Name:ROGER D OWENS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-532-7501
Mailing Address - Street 1:667 LANIER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2059
Mailing Address - Country:US
Mailing Address - Phone:770-532-7501
Mailing Address - Fax:770-532-8322
Practice Address - Street 1:667 LANIER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2059
Practice Address - Country:US
Practice Address - Phone:770-532-7501
Practice Address - Fax:770-532-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D05542OtherRAILROAD MEDICARE
GA00114298AMedicaid
GA07397OtherBLUE CROSS BLUE SHIELD
511G700374Medicare PIN
D40788Medicare UPIN