Active NPI
George Philip Fowles, ED.D.
- Clinical Neuropsychologist
- Raleigh, NC
National Provider Identifier
1396857025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 1260
- Practice address
- 3000 New Bern Ave
Wakemed Neuropsychology
Raleigh, NC 27610-1231 - Phone
- (919) 350-8866
- Fax
- (919) 350-7130
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 1260 | NC | Primary |
Addresses
Primary practice location
3000 New Bern Ave
Wakemed Neuropsychology
Raleigh, NC 27610-1231
Mailing address
3000 New Bern Ave.
Wakemed Neuropsychology
Raleigh, NC 27610
Phone (919) 350-8866
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046RM | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1260 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396857025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 NEW BERN AVE.",
"address_2": "WAKEMED NEUROPSYCHOLOGY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "27610",
"telephone_number": "919-350-8866",
"fax_number": "919-350-7130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 NEW BERN AVE",
"address_2": "WAKEMED NEUROPSYCHOLOGY",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276101231",
"telephone_number": "919-350-8866",
"fax_number": "919-350-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOWLES",
"first_name": "GEORGE",
"middle_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NC",
"license": "1260",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046RM",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.