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1760430003

NPI Code Detail

MEDICARE: LAWRENCE DONALD POWELL MD

MEDICARE: LAWRENCE DONALD POWELL MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	038915	GA
2	207Q00000X	Family Medicine Physician	038915	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760430003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE DONALD POWELL MD

Provider Business Mailing Address
First Line	:	720 WESTVIEW DR SW
Second Line	:	SUITE 100-A
City	:	ATLANTA
State	:	GA
Zip	:	30310-1458
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-1402

Provider Business Practice Location Address
First Line	:	1595 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3200
Country	:	US
Telephone Number	:	404-616-2886
Fax Number	:	404-209-1769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/29/2016

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Directions to “ LAWRENCE DONALD POWELL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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