Basic Information
| Provider Information | |||||||||
| NPI: | 1366863532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | WINN ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1061 HARMON AVE | ||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356933 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WINN ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1061 HARMON AVE | ||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356933 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2013 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 071157 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01387850 | 01 | FL | RR MEDICARE | OTHER | P01414083 | 01 | GA | RR MEDICARE | OTHER |