Provider Demographics
NPI:1922006360
Name:NOWLIN, PHILLIP W (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:W
Last Name:NOWLIN
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 1:115 AMBULANCE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3855
Mailing Address - Country:US
Mailing Address - Phone:404-759-7535
Mailing Address - Fax:770-834-7100
Practice Address - Street 1:115 AMBULANCE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:404-759-7535
Practice Address - Fax:770-834-7100
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036588207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000545003FMedicaid
GA511G700201Medicare PIN
GA511I080164Medicare UPIN
GA000545003FMedicaid
GAF61269Medicare UPIN
GA08BBQNGMedicare ID - Type UnspecifiedPROVIDER ID