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General NPI Number Information
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NPI Number | 1578869046
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Entity Type | Individual
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Provider Name | DONALD RUBERTINO POWELL DPM
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE STE 1615
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City | ATLANTA
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State | GA
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Zip | 30308-2212
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Country | US
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Telephone | 678-702-0620
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Fax | 678-702-0621
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Provider Business Mailing Address
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Address Line | 1975 HIGHWAY 54 W SUITE 205
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4794
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Country | US
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Telephone | 678-561-9000
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Fax | 770-487-1232
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD00135
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3482
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License Number State | FL
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