MEDICARE: DR. THERESA LIBO-ON KOWALSKI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710399274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA LIBO-ON KOWALSKI M.D.

Provider Business Mailing Address
First Line	:	2336 DAWSON RD STE 2200
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2801
Country	:	US
Telephone Number	:	229-312-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 DAWSON RD STE 2200
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-2801
Country	:	US
Telephone Number	:	229-312-8800
Fax Number	:

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	07/21/2022

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