Provider Demographics
NPI:1114010295
Name:POWELL, MARGARET O (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:O
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6075 POPLAR AVE
Mailing Address - Street 2:SUITE 727
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4740
Mailing Address - Country:US
Mailing Address - Phone:866-291-8600
Mailing Address - Fax:901-795-6060
Practice Address - Street 1:6075 POPLAR AVE
Practice Address - Street 2:SUITE 727
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4740
Practice Address - Country:US
Practice Address - Phone:866-291-8600
Practice Address - Fax:901-795-6060
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13202207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS8009711Medicaid
MS8009711Medicaid
MSE94338Medicare UPIN