NPIMap

Individual provider Active NPI

Timothy Dale Fowler Jr., P.A.

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1073532404
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
003482 Issued in GA
Practice address
601 E Rollins St
Orlando, FL 32803-1248
Phone
(407) 543-5732
NPI assigned
Jul 18, 2006
Last updated
Jun 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003482 GA Primary

Addresses

Primary practice location

601 E Rollins St
Orlando, FL 32803-1248

Mailing address

209 N Cuthbert St
Colquitt, GA 39837-3518
Phone (229) 758-4864

Other practice location 1

209 N Cuthbert St
Colquitt, GA 39837-3518
Phone (229) 758-4864

Other identifiers 2

IdentifierTypeStateIssuer
022250400MedicaidFL
100002664BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL, AL, NY4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20050909000580 GA Practitioner - Physician Assistant 3577595578 Reassigns benefits to 6 organizations
I20171003005225 FL Practitioner - Physician Assistant 3577595578 Reassigns benefits to 7 organizations
I20230201002446 AL Practitioner - Physician Assistant 3577595578 Reassigns benefits to 2 organizations
I20240213002726 NY Practitioner - Physician Assistant 3577595578 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Walton Rural Hospital LLCGroup PAC ID 8123559168, 29 clinicians

Practice addresses (Care Compare)

4413 US Hwy 331 S
Defuniak Springs, FL 32435-6307
Phone (850) 920-2065

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003482GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Nes Tennessee Inc CurrentSince Jan 19, 2023 Accepting new patients
Cep America LLC CurrentSince Apr 1, 2024 Accepting new patients
The Pathology Group of Northwest Florida PLLC Current Accepting new patients
FL-I Medical Services LLC Physician Assistant CurrentSince Sep 5, 2018 Accepting new patients
Phoebe Sumter Medical Center, Inc. CurrentSince May 9, 2014 Accepting new patients
Southland-Nashville Emergency Services, LLC. CurrentSince May 16, 2018 Accepting new patients
FL-I Medical Services LLC Physician Assistant CurrentSince Sep 5, 2018 Accepting new patients
Cep America LLC CurrentSince Apr 1, 2024 Accepting new patients
North Walton Rural Hospital, LLC CurrentSince Aug 3, 2025 Accepting new patients
Vivid Pathology PA Current Accepting new patients
Nes Medical Services of New York PC CurrentSince Sep 21, 2024 Accepting new patients
Holmes County Hospital Corp CurrentSince Jul 4, 2020 Accepting new patients
Stabler Clinic, P.C. Past Accepting new patients
Sterling Emergency Services of the Southeast Inc Past Accepting new patients

Locations

29 L V Stabler Dr
Greenville, AL 36037
Phone (334) 382-2676

315 W Hickory St
Sylacauga, AL 35150
Phone (256) 249-5000

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

2600 Hospital Dr
Bonifay, FL 32425
Phone (850) 416-6484

2020 59th St W
Bradenton, FL 34209
Phone (813) 798-6303

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

4413 US Highway 331 S
Defuniak Springs, FL 32435
Phone (850) 892-5171

996 Airport Rd
Destin, FL 32541
Phone (615) 338-1250

1700 S 23rd St
Fort Pierce, FL 34950
Phone (772) 461-4000

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603

449 W 23rd St
Panama City, FL 32405
Phone (850) 747-7900

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

1221 E McPherson Ave
Nashville, GA 31639
Phone (229) 543-7100

7571 State Route 54
Bath, NY 14810
Phone (607) 776-8500

7300 State Highway 121
Ste 370374
McKinney, TX 75070

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1605/brand/1/csg/26/fhir/r4

Organizations & group practices 30

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 30

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1073532404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N CUTHBERT ST",
            "city": "COLQUITT",
            "state": "GA",
            "postal_code": "398373518",
            "telephone_number": "229-758-4864",
            "fax_number": "229-758-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-543-5732"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 N Cuthbert St",
            "address_purpose": "LOCATION",
            "city": "Colquitt",
            "state": "GA",
            "postal_code": "398373518",
            "country_code": "US",
            "telephone_number": "229-758-4864",
            "fax_number": "229-758-8473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "TIMOTHY",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022250400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002664B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.