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General NPI Number Information
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NPI Number | 1841827706
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Entity Type | Individual
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Provider Name | MARY CAITLIN POWELL SOK PHD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1059
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Country | US
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Telephone | 404-778-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 630 JOHN WESLEY DOBBS AVE NE
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City | ATLANTA
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State | GA
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Zip | 30312-1660
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Country | US
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Telephone | 724-272-9762
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 93515
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License Number State | GA
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