Provider Demographics
NPI:1093519837
Name:FOWLER, RAPHAEL B (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:B
Last Name:FOWLER
Suffix:
Gender:
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 PEACHTREE CORNERS CIR APT I
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4351
Mailing Address - Country:US
Mailing Address - Phone:678-542-9756
Mailing Address - Fax:
Practice Address - Street 1:3387 PEACHTREE CORNERS CIR APT I
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4351
Practice Address - Country:US
Practice Address - Phone:678-542-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276645363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health