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NPI Code Detail

MEDICARE: MYSEANTINIQUE POWELL

MEDICARE: MYSEANTINIQUE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1770368284
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYSEANTINIQUE POWELL
Provider Business Mailing Address
First Line : 103 LIVE OAK ST
Second Line :
City : POOLER
State : GA
Zip : 31322-3033
Country : US
Telephone Number : 912-441-4316
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCE CT
Second Line :
City : POOLER
State : GA
Zip : 31322-9445
Country : US
Telephone Number : 615-560-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2023
Last Update Date : 08/31/2023

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Directions to “ MYSEANTINIQUE POWELL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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