MEDICARE: KIMONE POWELL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN310265	GA

General Provider Information

NPI Number	:	1548007636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMONE POWELL

Provider Business Mailing Address
First Line	:	4546 BARCLAY DR STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-7146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 BARCLAY DR STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-7146
Country	:	US
Telephone Number	:	321-557-8348
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	06/05/2026

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Directions to “ KIMONE POWELL ” Practice Location

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