MEDICARE: MR. PETER JOHN KOWALSKI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1518122605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER JOHN KOWALSKI PA-C

Provider Business Mailing Address
First Line	:	113 MELROSE AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410-1302
Country	:	US
Telephone Number	:	912-898-4847
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 MINIS AVE
Second Line	:	SUITE C10
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2128
Country	:	US
Telephone Number	:	912-966-5445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	10/28/2009

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