=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528052248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JAMES A. POWELL, JR., D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2005
-----------------------------------------------------
Last Update Date | 02/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1444 TIFT AVE N STE B
-----------------------------------------------------
City | TIFTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31794-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-382-3210
-----------------------------------------------------
Fax | 229-382-3213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1444 TIFT AVE N STE B
-----------------------------------------------------
City | TIFTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31794-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-382-3210
-----------------------------------------------------
Fax | 229-382-3213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. JAMES AMBUS POWELL JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 229-382-3210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7050
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------