Healthcare Provider Details

I. General information

NPI: 1518921626
Provider Name (Legal Business Name): RONALD POWELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MEDICAL CENTER DR
WEST POINT MS
39773-9317
US

IV. Provider business mailing address

740 MEDICAL CENTER DR
WEST POINT MS
39773-9317
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-8500
  • Fax: 662-494-8488
Mailing address:
  • Phone: 662-494-8500
  • Fax: 662-494-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number09038
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: