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1548976590 NPI number — MARION STEPHENSON FOWLER III M.D.

NPI Number: 1548976590
Health Care Provider/Practitioner: MARION STEPHENSON FOWLER III M.D.

Information about “1548976590” NPI (MARION STEPHENSON FOWLER III M.D.) exists in 1548976590 in HTML format HTML  |  1548976590 in plain Text format TXT  |  1548976590 in PDF (Portable Document Format) PDF  |  1548976590 in an XML format XML  formats.

NPI Number : 1548976590 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548976590",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOWLER",
    "FirstName": "MARION",
    "MiddleName": "STEPHENSON",
    "NamePrefix": "MR.",
    "NameSuffix": "III",
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "207 LOCKEWOOD DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE CITY",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29560",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "207 LOCKEWOOD DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE CITY",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29560",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-373-1244",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/24/2023",
    "LastUpdateDate": "03/15/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208D00000X",
        "TaxonomyName": "General Practice Physician",
        "LicenseNumber": "MD11574",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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