Provider Demographics
NPI:1710399274
Name:KOWALSKI, THERESA LIBO-ON (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LIBO-ON
Last Name:KOWALSKI
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 1:2336 DAWSON RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2801
Mailing Address - Country:US
Mailing Address - Phone:229-312-8800
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD STE 2200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2801
Practice Address - Country:US
Practice Address - Phone:229-312-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program