Provider Demographics
NPI:1992984496
Name:JOHN C. STOWELL, MD, PA
Entity type:Organization
Organization Name:JOHN C. STOWELL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:COLBY
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-487-3904
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29342-0968
Mailing Address - Country:US
Mailing Address - Phone:864-487-3904
Mailing Address - Fax:
Practice Address - Street 1:117 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3058
Practice Address - Country:US
Practice Address - Phone:864-487-3904
Practice Address - Fax:864-489-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080067Medicaid
SC2480Medicare PIN