Provider Demographics
NPI:1033203492
Name:FOWLER, ANGY M (RN)
Entity Type:Individual
Prefix:
First Name:ANGY
Middle Name:M
Last Name:FOWLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGY
Other - Middle Name:M
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1428 RICE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CANON
Mailing Address - State:GA
Mailing Address - Zip Code:30520
Mailing Address - Country:US
Mailing Address - Phone:706-245-9720
Mailing Address - Fax:
Practice Address - Street 1:6955 HWY145 SOUTH
Practice Address - Street 2:
Practice Address - City:CARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30521
Practice Address - Country:US
Practice Address - Phone:706-384-5575
Practice Address - Fax:706-384-4217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 139417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse