Provider Demographics
NPI:1871348045
Name:BOWERS, JACKSON PHILLIP
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:PHILLIP
Last Name:BOWERS
Suffix:
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 1:12817 SANDPIPER GROVE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0093
Mailing Address - Country:US
Mailing Address - Phone:980-395-4600
Mailing Address - Fax:
Practice Address - Street 1:3800 VICTORY PARKWAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207
Practice Address - Country:US
Practice Address - Phone:513-745-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program