Provider Demographics
NPI:1174244701
Name:LOWELL, COURTNEY MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MARIE
Last Name:LOWELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1628 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7927
Mailing Address - Country:US
Mailing Address - Phone:770-888-3102
Mailing Address - Fax:470-297-8620
Practice Address - Street 1:5720 BUFORD HWY STE 102
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2574
Practice Address - Country:US
Practice Address - Phone:770-888-3102
Practice Address - Fax:770-729-1676
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA3043048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3043048OtherGA NURSE PRACTITIONER LICENSE NUMBER