Basic Information
| Provider Information | |||||||||
| NPI: | 1114010295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POWELL | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | MARGARET | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6075 POPLAR AVE | ||||||||
| Address2: | SUITE 727 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381194740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662918600 | ||||||||
| FaxNumber: | 9017956060 | ||||||||
| Practice Location | |||||||||
| Address1: | 6075 POPLAR AVE | ||||||||
| Address2: | SUITE 727 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381194740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662918600 | ||||||||
| FaxNumber: | 9017956060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13202 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 13202 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8009711 | 05 | MS | MEDICAID |