Individual
DIANA M FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA/AA
Contact information
Practice address
380 HOSPITAL DRIVE, SUITE 410, MACON, GA 31217
(478) 746-5644
(478) 745-4849
Mailing address
PO BOX 2564, MACON, GA 31203
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
002468
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001578A
—
GA
05
—
100001578B
—
GA
05
—
100001578C
—
GA
05
—
100001578D
—
GA
01
—
336920
WELLCARE
GA
01
—
970026294
RAILROAD MEDICARE
GA
Enumeration date
08/04/2006
Last updated
08/25/2021
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