Healthcare Provider Details

I. General information

NPI: 1003800426
Provider Name (Legal Business Name): WILLIAM EDWARD FOWLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 COKESBURY RD
HODGES SC
29653
US

IV. Provider business mailing address

105 VINE CREST COURT SUITE 700
GREENWOOD SC
29646
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-2099
  • Fax: 864-227-1779
Mailing address:
  • Phone: 864-943-4859
  • Fax: 864-943-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15728
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: