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General NPI Number Information
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NPI Number | 1780048348
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Entity Type | Individual
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Provider Name | CORNELIUS POWELL III M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | GME1000 BLYTHE BLVD., MEB, SUITE 157 CAROLINAS MEDICAL CENTER
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City | CHARLOTTE
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State | NC
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Zip | 28203-2861
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Country | US
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Telephone | 704-446-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 387 BOONESBORO RD
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City | JOHNSON CITY
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State | TN
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Zip | 37615-4206
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Country | US
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Telephone | 423-943-5577
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 218133
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License Number State | NC
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