Provider Demographics
NPI:1003800426
Name:FOWLER, WILLIAM EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 VINE CREST COURT
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-943-4859
Mailing Address - Fax:864-943-0718
Practice Address - Street 1:3410 COKESBURY RD
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:SC
Practice Address - Zip Code:29653
Practice Address - Country:US
Practice Address - Phone:864-227-2099
Practice Address - Fax:864-227-1779
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC15728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL11299Medicaid
SCE99177Medicare UPIN