Active NPI
Brenda Jo Kowalske, M.D.
- Internal Medicine Physician
- Gainesville, GA
National Provider Identifier
1710185889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35940
- Practice address
- 1715 Cleveland Hwy
Gainesville, GA 30501-1357 - Phone
- (404) 276-7358
- NPI assigned
- Jul 10, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35940 | GA | Primary |
Addresses
Primary practice location
1715 Cleveland Hwy
Gainesville, GA 30501-1357
Mailing address
1715 Cleveland Hwy
Gainesville, GA 30501-1357
Phone (404) 276-7358
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 932229 | Medicaid | AZ | |
| 88173542 | Medicaid | CO | |
| 76085261 | Medicaid | NM |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35940 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Fort Defiance Hospital | Past | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Past | Accepting new patients | |
| Gwinnett Dermatology PC D/B/a Georgia Dermatology Partners | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Dermatology Physician
- Snellville, GA
- NPI 1477596203
-
dba PHS Fort Defiance Indian Hospital
- General Acute Care Hospital
- Fort Defiance, AZ
- NPI 1700962131
-
dba Wanblee Health Center
- Clinic/Center
- Wanblee, SD
- NPI 1962559518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1710185889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1715 CLEVELAND HWY",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305011357",
"telephone_number": "404-276-7358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 CLEVELAND HWY",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305011357",
"telephone_number": "404-276-7358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOWALSKE",
"first_name": "BRENDA",
"middle_name": "JO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-10",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "35940",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "932229",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "88173542",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "76085261",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.