Healthcare Provider Details

I. General information

NPI: 1730048240
Provider Name (Legal Business Name): JACOB POWERS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 330
MACON GA
31217-3895
US

IV. Provider business mailing address

623 S HOUSTON LAKE RD STE 200
WARNER ROBINS GA
31088-9094
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-8152
  • Fax:
Mailing address:
  • Phone: 478-923-4403
  • Fax: 478-923-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN275742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: