Provider Demographics
NPI:1619204476
Name:FOWLER, CARLEY O'SHEA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:O'SHEA
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:MCCARLEY
Other - Last Name:O'SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3373
Mailing Address - Country:US
Mailing Address - Phone:865-470-4127
Mailing Address - Fax:951-257-0143
Practice Address - Street 1:220 FORT SANDERS WEST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3373
Practice Address - Country:US
Practice Address - Phone:865-470-4127
Practice Address - Fax:865-524-0224
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015923207N00000X
TN50432207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology