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General NPI Number Information
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NPI Number | 1700793916
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Entity Type | Individual
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Provider Name | SAMWISE WYNNSOME FOWLER MSW, LCSWA
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Gender | Male
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 950 GRAVES ST
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3262
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Country | US
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Telephone | 336-497-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 EDITH LN APT A
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City | GREENSBORO
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State | NC
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Zip | 27409-2898
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Country | US
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Telephone | 336-455-3413
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P024279
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License Number State | NC
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