Healthcare Provider Details

I. General information

NPI: 1821072398
Provider Name (Legal Business Name): GEORGE EDMUND POWELL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE EDMUND POWELL III MD

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 HAMPTON AVE STE A
BRUNSWICK GA
31520-4226
US

IV. Provider business mailing address

3226 HAMPTON AVE STE A
BRUNSWICK GA
31520-4226
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-0760
  • Fax: 912-264-5798
Mailing address:
  • Phone: 912-264-0760
  • Fax: 912-264-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: