MEDICARE: EMILY 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	363L00000X	Nurse Practitioner	APRN-NP295561	GA

General Provider Information

NPI Number	:	1255296976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY FOWLER

Provider Business Mailing Address
First Line	:	26 HEATHERWOOD TRCE
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-5953
Country	:	US
Telephone Number	:	770-757-6160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 COBB PARKWAY NORTH NW
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4180
Country	:	US
Telephone Number	:	470-956-0050
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ EMILY FOWLER ” Practice Location

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