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1538131933

NPI Code Detail

MEDICARE: JOHN BRIAN FOWLER MD

MEDICARE: JOHN BRIAN FOWLER MD

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	208M00000X	Hospitalist Physician	19731	SC
2	207R00000X	Internal Medicine Physician	19731	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO1240739	OTHER	SC	RAILROAD MEDICARE
2	G910385019	OTHER	SC	MEDICARE PIN
4	SCA4519225	OTHER	SC	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538131933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRIAN FOWLER MD

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:	864-560-4304
Fax Number	:	864-560-4413

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD STE 2500
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4214
Country	:	US
Telephone Number	:	864-585-5433
Fax Number	:

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/31/2019

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Directions to “ JOHN BRIAN FOWLER MD” Practice Location

Language	Start Address	Practice Location

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