Basic Information
| Provider Information | |||||||||
| NPI: | 1497983589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWERS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | FARLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936857 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311936857 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1725 NEW HANOVER MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284035345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106629300 | ||||||||
| FaxNumber: | 9106622401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 201302150 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 2013-02150 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 302150 | 05 | SC | MEDICAID | 1497983589 | 05 | NC | MEDICAID |