Healthcare Provider Details

I. General information

NPI: 1497787790
Provider Name (Legal Business Name): WILLIAM SULLIVAN POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEWEY AVE
SPARTANBURG SC
29303-3009
US

IV. Provider business mailing address

1075 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-0366
  • Fax:
Mailing address:
  • Phone: 864-583-7265
  • Fax: 864-591-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5096
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: