Provider Demographics
NPI:1396857025
Name:FOWLES, GEORGE PHILIP (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PHILIP
Last Name:FOWLES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE.
Mailing Address - Street 2:WAKEMED NEUROPSYCHOLOGY
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-350-8866
Mailing Address - Fax:919-350-7130
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:WAKEMED NEUROPSYCHOLOGY
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-8866
Practice Address - Fax:919-350-7130
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1260103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046RMMedicaid
NC046RMMedicaid