Healthcare Provider Details

I. General information

NPI: 1124984166
Provider Name (Legal Business Name): JIMMIE LEE FOWLER III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 LOLA ST
COLBERT GA
30628-6644
US

IV. Provider business mailing address

181 LOLA ST
COLBERT GA
30628-6644
US

V. Phone/Fax

Practice location:
  • Phone: 706-296-1979
  • Fax: 706-296-1979
Mailing address:
  • Phone: 706-296-1979
  • Fax: 706-296-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberRN285050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: