Provider Demographics
NPI:1568667723
Name:FOWLER, BLAKLEY ATKINS (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKLEY
Middle Name:ATKINS
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ALCORN DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9072
Mailing Address - Country:US
Mailing Address - Phone:662-293-7390
Mailing Address - Fax:
Practice Address - Street 1:401 ALCORN DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9072
Practice Address - Country:US
Practice Address - Phone:662-293-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics