Provider Demographics
NPI:1457792657
Name:JAMES Z BOWCOCK MD PC
Entity type:Organization
Organization Name:JAMES Z BOWCOCK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ZITZER
Authorized Official - Last Name:BOWCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-417-2764
Mailing Address - Street 1:PO BOX 920520
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-0520
Mailing Address - Country:US
Mailing Address - Phone:770-417-2764
Mailing Address - Fax:770-447-0811
Practice Address - Street 1:4530 S BERKELEY LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1660
Practice Address - Country:US
Practice Address - Phone:770-417-2764
Practice Address - Fax:770-447-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8040OtherSTATE LICENSE
GA8040OtherSTATE LICENSE