Healthcare Provider Details

I. General information

NPI: 1063671188
Provider Name (Legal Business Name): STEPHANIE J POWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 GUILFORD COLLEGE RD STE 117 SUITE 216
JAMESTOWN NC
27282-9875
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-856-0801
  • Fax: 336-856-2804
Mailing address:
  • Phone: 336-856-0801
  • Fax: 336-856-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011-01307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: