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General NPI Number Information
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NPI Number | 1003020868
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Entity Type | Organization
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Legal Business Name | ANDREW J POWELL MD, PLLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25 HICKORY BEND DR
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City | CABOT
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State | AR
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Zip | 72023-8183
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Country | US
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Telephone | 501-605-1144
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Fax | 501-605-1144
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | CABOT
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State | AR
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Zip | 72023-0500
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Country | US
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Telephone | 501-605-1144
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Fax | 501-605-1144
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACI G POWELL
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Credential |
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Telephone | 501-605-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MC-2391
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License Number State | AR
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