Individual
SIMON CHARLES FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1615 RIDENOUR BLVD NW, KENNESAW, GA 30152-4463
(770) 580-8070
Mailing address
3393 ORANGE LN NW, ACWORTH, GA 30101-6372
(404) 600-7684
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA005007
GA
Other
Enumeration date
02/03/2023
Last updated
02/03/2023
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