Healthcare Provider Details

I. General information

NPI: 1760430003
Provider Name (Legal Business Name): LAWRENCE DONALD POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 CLEVELAND AVE
EAST POINT GA
30344-3200
US

IV. Provider business mailing address

720 WESTVIEW DR SW SUITE 100-A
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-2886
  • Fax: 404-209-1769
Mailing address:
  • Phone: 404-756-1400
  • Fax: 404-756-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number038915
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038915
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: