Individual
MR. JEREMIAH JERELL FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
418 ELM ST SW, POULAN, GA 31781-3736
(229) 296-7907
Mailing address
418 ELM ST SW, POULAN, GA 31781-3736
(229) 296-7907
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002755
GA
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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