Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2110 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | 2110 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2110 | GA |
NPI | 1477735306 |
---|---|
Provider Name | Dr. Raymond Paul Fowler |
First Address | Roswell, GA 30076-5612 |
Second Address | Roswell, GA 30076-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2007 |
Last Update Date | 05/10/2010 |