Organization
PREMIERCARE OMEGA
Active
Other names
Premiercare Omega LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CLYDE BOWMAN MD (PRESIDENT)
(229) 387-4802
Entity
Organization
Contact information
Practice address
130 MOORE ST, OMEGA, GA 31775-3075
(229) 528-6500
(229) 528-3283
Mailing address
130 MOORE ST, OMEGA, GA 31775-3075
(229) 528-6500
(229) 528-3283
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
256884477
FAMILY MEDICINE
—
Enumeration date
03/23/2020
Last updated
05/05/2020
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