Provider Demographics
NPI:1851398093
Name:FOWLER, PRISCILLA GOODWYN (MD)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:GOODWYN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59449
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35259-9449
Mailing Address - Country:US
Mailing Address - Phone:205-876-8988
Mailing Address - Fax:205-390-6460
Practice Address - Street 1:1720 UNIVERSITY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-876-8988
Practice Address - Fax:205-390-6460
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA442125207W00000X
FLME90933207W00000X
AL23473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271326800Medicaid
FL5865700001OtherMEDICARE DME
H81519Medicare UPIN
FL48163ZMedicare PIN