Basic Information
| Provider Information | |||||||||
| NPI: | 1447390315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWLER | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OLIVER | ||||||||
| OtherFirstName: | MIKAELA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD | ||||||||
| Address2: | STE 510 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705070029 | ||||||||
| FaxNumber: | 6785817170 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 NORTHSIDE CHEROKEE BLVD STE 450 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301158020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707213200 | ||||||||
| FaxNumber: | 7707211890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 004976 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 500839855A | 05 | GA | MEDICAID | 500839855B | 05 | GA | MEDICAID | 500839855C | 05 | GA | MEDICAID |