Healthcare Provider Details

I. General information

NPI: 1225963135
Provider Name (Legal Business Name): REBEKAH ELISE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N TENNESSEE ST STE 107
CARTERSVILLE GA
30120-2890
US

IV. Provider business mailing address

815 MOUNTAIN PARK CT SE
CARTERSVILLE GA
30121-5050
US

V. Phone/Fax

Practice location:
  • Phone: 770-368-6182
  • Fax:
Mailing address:
  • Phone: 404-333-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: