Individual
MANDI C FOWLER
Active
Individual
MANDI C FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3873
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
647119263A
—
GA
05
—
875872035B
—
GA
05
—
875872035C
—
GA
05
—
875872035D
—
GA
05
—
875872035E
—
GA
05
—
875872035F
—
GA
Enumeration date
10/04/2005
Last updated
11/14/2022
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