MEDICARE: TASHI POWELL APRN

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	2025097731	GA

General Provider Information

NPI Number	:	1942151394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHI POWELL APRN

Provider Business Mailing Address
First Line	:	1415 HIGHWAY 85 N
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 HIGHWAY 85 N
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7738
Country	:	US
Telephone Number	:	404-397-8701
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ TASHI POWELL APRN” Practice Location

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