Healthcare Provider Details

I. General information

NPI: 1316402092
Provider Name (Legal Business Name): MELISSA FOWLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 12/05/2019
Reactivation Date: 12/10/2019

III. Provider practice location address

8 RICHLAND MEDICAL PARK DR STE 300
COLUMBIA SC
29203-8008
US

IV. Provider business mailing address

8 RICHLAND MEDICAL PARK DR STE 300
COLUMBIA SC
29203-8008
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3800
  • Fax:
Mailing address:
  • Phone: 803-434-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3197
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: