MEDICARE: MICHAEL S POWELL

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1679142426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S POWELL

Provider Business Mailing Address
First Line	:	2227 DRAKE AVE SW STE 28
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5146
Country	:	US
Telephone Number	:	256-536-6644
Fax Number	:	256-536-8610

Provider Business Practice Location Address
First Line	:	2227 DRAKE AVE SW STE 28
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5146
Country	:	US
Telephone Number	:	256-536-6644
Fax Number	:	256-536-8610

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DANIEL POWELL
Credential	:
Telephone Number	:	256-533-6644

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	12/19/2022

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