Provider Demographics
NPI:1518122605
Name:KOWALSKI, PETER JOHN (PA-C)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1302
Mailing Address - Country:US
Mailing Address - Phone:912-898-4847
Mailing Address - Fax:
Practice Address - Street 1:109 MINIS AVE
Practice Address - Street 2:SUITE C10
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2128
Practice Address - Country:US
Practice Address - Phone:912-966-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I970453Medicare UPIN
GA511G700201Medicare PIN