Healthcare Provider Details

I. General information

NPI: 1144635103
Provider Name (Legal Business Name): RYAN PLOWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT JOSEPHS CANDLER DR STE 100
POOLER GA
31322-9587
US

IV. Provider business mailing address

101 SAINT JOSEPHS CANDLER DR STE 100
POOLER GA
31322-9587
US

V. Phone/Fax

Practice location:
  • Phone: 912-737-2250
  • Fax: 912-737-2257
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056690
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: