Individual
RAPHAEL B FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP-C
Contact information
Practice address
4958 MEMORIAL DR, STONE MOUNTAIN, GA 30083-4148
(678) 542-9756
Mailing address
3387 PEACHTREE CORNERS CIR APT I, PEACHTREE CORNERS, GA 30092-4351
(678) 542-9756
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN276645
GA
Other
Enumeration date
04/02/2025
Last updated
12/08/2025
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