Basic Information
| Provider Information | |||||||||
| NPI: | 1790775690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWRY | ||||||||
| FirstName: | GARNETT | ||||||||
| MiddleName: | MARCUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 896208 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282896208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107151010 | ||||||||
| FaxNumber: | 9107151026 | ||||||||
| Practice Location | |||||||||
| Address1: | 313 TEAL DR | ||||||||
| Address2: | |||||||||
| City: | RAEFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283762527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109042350 | ||||||||
| FaxNumber: | 9109041037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 06/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200101238 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6965764002 | 01 | CIGNA PAL | OTHER | FH1001465 | 01 | FIRST CAROLINA CARE | OTHER | 891303T | 05 | NC | MEDICAID | N01231 | 05 | SC | MEDICAID | 1303T | 01 | NC | BCBS | OTHER | 7248953 | 01 | AETNA | OTHER | B8019 | 01 | MEDCOST | OTHER |