Provider Demographics
NPI:1851398093
Name:FOWLER, PRISCILLA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:G
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 1:700 18TH ST S
Mailing Address - Street 2:SUITE 601
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1856
Mailing Address - Country:US
Mailing Address - Phone:205-488-0756
Mailing Address - Fax:205-325-8686
Practice Address - Street 1:700 18TH ST S
Practice Address - Street 2:SUITE 601
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1856
Practice Address - Country:US
Practice Address - Phone:205-488-0756
Practice Address - Fax:205-325-8686
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA442125207W00000X
FLME90933207W00000X
AL23473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271326800Medicaid
FL5865700001OtherMEDICARE DME
H81519Medicare UPIN
FL48163ZMedicare PIN