Provider Demographics
NPI:1700216280
Name:FOWLER, MICHAEL D I (ST, MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:FOWLER
Suffix:I
Gender:M
Credentials:ST, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S. MACARTHUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730
Mailing Address - Country:US
Mailing Address - Phone:229-375-4821
Mailing Address - Fax:
Practice Address - Street 1:198 S. MACARTHUR DRIVE
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730
Practice Address - Country:US
Practice Address - Phone:229-375-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management