MEDICARE: DR. JUNE ANNETTE POWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	KT2005001	AR

General Provider Information

NPI Number	:	1235194960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNE ANNETTE POWELL MD

Provider Business Mailing Address
First Line	:	611 ALCORN DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-9321
Country	:	US
Telephone Number	:	662-293-5590
Fax Number	:	662-293-4282

Provider Business Practice Location Address
First Line	:	611 ALCORN DR
Second Line	:
City	:	CORINTH
State	:	MS
Zip	:	38834-9321
Country	:	US
Telephone Number	:	662-293-5590
Fax Number	:	662-293-4282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/21/2008

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