MEDICARE: POWELL AND ASSOCIATES DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306104260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWELL AND ASSOCIATES DDS, PC

Provider Business Mailing Address
First Line	:	2800 SPRING ROAD
Second Line	:	SUITE F-2
City	:	ATLANTA
State	:	GA
Zip	:	30339-3092
Country	:	US
Telephone Number	:	770-319-9933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 SPRING ROAD
Second Line	:	SUITE F-2
City	:	ATLANTA
State	:	GA
Zip	:	30339-3092
Country	:	US
Telephone Number	:	770-319-9933
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROMETTA E POWELL
Credential	:	DDS
Telephone Number	:	770-319-9933

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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