MEDICARE: TERESA GRISWOLD FOWLER

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	363A00000X	Physician Assistant	4722	SC

General Provider Information

NPI Number	:	1033849195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA GRISWOLD FOWLER

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 GROVE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4210
Country	:	US
Telephone Number	:	864-455-7000
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	03/05/2026

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