Healthcare Provider Details

I. General information

NPI: 1518122605
Provider Name (Legal Business Name): PETER JOHN KOWALSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MINIS AVE SUITE C10
GARDEN CITY GA
31408-2128
US

IV. Provider business mailing address

113 MELROSE AVE
SAVANNAH GA
31410-1302
US

V. Phone/Fax

Practice location:
  • Phone: 912-966-5445
  • Fax:
Mailing address:
  • Phone: 912-898-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: