Healthcare Provider Details

I. General information

NPI: 1235846155
Provider Name (Legal Business Name): CAROLINE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

138 RIVENDELL DR
HIAWASSEE GA
30546-4008
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-3232
  • Fax:
Mailing address:
  • Phone: 770-841-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: