NPIMap

Individual provider Active NPI

Mandi C Fowler, PA-C

  • Medical Physician Assistant
  • Marietta, GA
National Provider Identifier
1891782900
Registry record updated Sep 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3873 Issued in GA
Practice address
268 Lawrence St NE
Marietta, GA 30060-1617
Phone
(770) 421-7738
Fax
(470) 986-7062
NPI assigned
Oct 4, 2005
Last updated
Sep 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3873 GA Primary

Addresses

Primary practice location

268 Lawrence St NE
Marietta, GA 30060-1617

Mailing address

268 Lawrence St NE Ste 100
Marietta, GA 30060-1617
Phone (770) 421-7738

Other names 1

  • Mandi L Czykyski Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mfowler497108@directwellstar.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051220000333 GA Practitioner - Physician Assistant 3870515760 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3873GAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Nov 1, 2022 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Nov 1, 2022 Accepting new patients
Hamilton Physician Group Inc Past Accepting new patients
Premise Health of Georgia Medical PC PastSince Aug 15, 2021 Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

Interoperability endpoints

  • Direct secure messaging: mfowler497108@directwellstar.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789948800000",
    "number": "1891782900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 LAWRENCE ST NE STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601617",
            "telephone_number": "770-421-7738",
            "fax_number": "470-986-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 LAWRENCE ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601617",
            "telephone_number": "770-421-7738",
            "fax_number": "470-986-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "MANDI",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2026-09-21",
        "certification_date": "2026-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "3873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfowler497108@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "677 Church St NE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MANDI",
            "last_name": "CZYKYSKI",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.