Provider Demographics
NPI:1124061593
Name:CLEVELAND, TONYA POWERS (MD)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:POWERS
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:KIM
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:893 MARTINS GOLD MINE RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:SC
Mailing Address - Zip Code:29743-9700
Mailing Address - Country:US
Mailing Address - Phone:704-616-7330
Mailing Address - Fax:
Practice Address - Street 1:893 MARTINS GOLD MINE RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:SC
Practice Address - Zip Code:29743-9700
Practice Address - Country:US
Practice Address - Phone:704-616-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253670207L00000X
NC9801450207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC216812Medicaid
NC050092405OtherMEDICARE ID
NC050082267OtherMEDICARE ID
NC130R0OtherBLUE CROSS
NC8913OROMedicaid
VAVVB587BMedicare PIN
NC130R0OtherBLUE CROSS
SC216812Medicaid