Healthcare Provider Details

I. General information

NPI: 1396857025
Provider Name (Legal Business Name): GEORGE PHILIP FOWLES ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE WAKEMED NEUROPSYCHOLOGY
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3000 NEW BERN AVE. WAKEMED NEUROPSYCHOLOGY
RALEIGH NC
27610
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8866
  • Fax: 919-350-7130
Mailing address:
  • Phone: 919-350-8866
  • Fax: 919-350-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1260
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: