MEDICARE: CHARLES HILL POWELL III PA-C

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	363A00000X	Physician Assistant	PA0000003764	TN
2	363AM0700X	Medical Physician Assistant	3764	TN

General Provider Information

NPI Number	:	1477013381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HILL POWELL III PA-C

Provider Business Mailing Address
First Line	:	PO BOX 440332
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37244-0332
Country	:	US
Telephone Number	:	865-670-6199
Fax Number	:	865-670-6198

Provider Business Practice Location Address
First Line	:	5779 CREEKWOOD PARK BLVD
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-1203
Country	:	US
Telephone Number	:	865-988-6330
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	07/26/2019

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