Individual
MS. MICHELLE LEIGH KOWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 532-7179
(770) 534-1312
Mailing address
PO BOX 1076, GAINESVILLE, GA 30503-1076
(770) 532-7179
(770) 534-1312
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CH8781
FL
367H00000X
Anesthesiologist Assistant
Primary
007263
GA
367H00000X
Anesthesiologist Assistant
2012018775
MO
367H00000X
Anesthesiologist Assistant
9
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396819363
—
MO
01
—
431560263
TRICARE
MO
01
—
P01089880
RR MCR
MO
Enumeration date
11/20/2006
Last updated
10/07/2014
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