Provider Demographics
NPI:1689615429
Name:FOWLER, JAMES LYMAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LYMAN
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W ALEXANDER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4009
Mailing Address - Country:US
Mailing Address - Phone:864-223-0505
Mailing Address - Fax:864-223-7075
Practice Address - Street 1:305 W ALEXANDER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4009
Practice Address - Country:US
Practice Address - Phone:864-223-0505
Practice Address - Fax:864-223-7075
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201432082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG52720Medicaid
SC576007863143OtherBCBS OF SC
SC1976545OtherCIGNA
SCG52720Medicaid
SCP00377393OtherRR MEDICARE
SCH87854Medicare UPIN
SC576007863143OtherBCBS OF SC
SC1976545OtherCIGNA