Provider Demographics
NPI:1518336023
Name:FOWLER, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11170 SERENBE LN
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE HILLS
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2546
Mailing Address - Country:US
Mailing Address - Phone:740-404-9677
Mailing Address - Fax:
Practice Address - Street 1:1557 JANMAR RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5686
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:678-666-5201
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.2409 TL363A00000X
GA8417363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant