Healthcare Provider Details

I. General information

NPI: 1841130317
Provider Name (Legal Business Name): MATTHEW JACOB POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

IV. Provider business mailing address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number111971
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: