Individual
DR. LISA FAY FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1230 BAXTER ST, ATHENS, GA 30606-3712
(706) 389-3420
(706) 389-3411
Mailing address
1230 BAXTER ST, PO BOX 7695, ATHENS, GA 30606-3712
(706) 389-3420
(706) 389-3411
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48289
GA
208M00000X
Hospitalist Physician
Primary
48289
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000862364B
—
GA
Enumeration date
08/11/2006
Last updated
08/17/2021
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