Provider Demographics
NPI:1477735306
Name:FOWLER, RAYMOND PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PAUL
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SUN VALLEY DR
Mailing Address - Street 2:SUITE G-3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5612
Mailing Address - Country:US
Mailing Address - Phone:770-641-8283
Mailing Address - Fax:770-993-8034
Practice Address - Street 1:555 SUN VALLEY DR
Practice Address - Street 2:SUITE G-3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5612
Practice Address - Country:US
Practice Address - Phone:770-641-8283
Practice Address - Fax:770-993-8034
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2110111N00000X, 111NR0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic