Provider Demographics
NPI:1366522211
Name:LOWE, ENOCH MARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:ENOCH
Middle Name:MARRELL
Last Name:LOWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3613 BRASELTON HWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4665
Mailing Address - Country:US
Mailing Address - Phone:678-546-3027
Mailing Address - Fax:678-546-3356
Practice Address - Street 1:3613 BRASELTON HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4665
Practice Address - Country:US
Practice Address - Phone:678-546-3027
Practice Address - Fax:678-546-3356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000749889AMedicaid
GA000749889AMedicaid
GAG57916Medicare UPIN