Provider Demographics
NPI:1235931734
Name:BOWENS, RICTAVIOUS (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:RICTAVIOUS
Middle Name:
Last Name:BOWENS
Suffix:
Gender:
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BOWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:677 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-793-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program