Provider Demographics
NPI:1811303571
Name:BOWMAN, JOHNNY III
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:BOWMAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 BRANDEMERE LN APT A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6445
Mailing Address - Country:US
Mailing Address - Phone:336-577-3831
Mailing Address - Fax:
Practice Address - Street 1:7104 BRANDEMERE LN APT A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-6445
Practice Address - Country:US
Practice Address - Phone:336-577-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide