Healthcare Provider Details

I. General information

NPI: 1578591988
Provider Name (Legal Business Name): JOHN D POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 CONNELLY SPRINGS RD
LENOIR NC
28645-7827
US

IV. Provider business mailing address

321 MULBERRY ST SW MEDICAL STAFF SERVICES
LENOIR NC
28645-5720
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-6300
  • Fax: 828-757-6324
Mailing address:
  • Phone: 828-757-5965
  • Fax: 828-757-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96-01440
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: