MEDICARE: ANGY M. FOWLER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN 139417	GA

General Provider Information

NPI Number	:	1033203492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGY M. FOWLER RN

Provider Business Mailing Address
First Line	:	1428 RICE CREEK ROAD
Second Line	:
City	:	CANON
State	:	GA
Zip	:	30520
Country	:	US
Telephone Number	:	706-245-9720
Fax Number	:

Provider Business Practice Location Address
First Line	:	6955 HWY145 SOUTH
Second Line	:
City	:	CARNESVILLE
State	:	GA
Zip	:	30521
Country	:	US
Telephone Number	:	706-384-5575
Fax Number	:	706-384-4217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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