Individual
MR. KEITH FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
3717 MEADOW VISTA TRL, LITHONIA, GA 30038-7736
(404) 803-0110
Mailing address
PO BOX 361972, DECATUR, GA 30036-1972
(404) 803-0110
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Enumeration date
09/24/2006
Last updated
07/08/2007
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