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General NPI Number Information
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NPI Number | 1063749588
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Entity Type | Individual
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Provider Name | DAVID H FOWLER CNS/PMH
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Gender | Male
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 306 SHORTER AVE
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City | ROME
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State | GA
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Zip | 30165
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Country | US
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Telephone | 706-509-3559
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Fax | 706-802-2869
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Provider Business Mailing Address
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Address Line | PO BOX 1882
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City | ROME
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State | GA
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Zip | 30162
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Country | US
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Telephone | 706-509-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN050746
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License Number State | GA
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