Provider Demographics
NPI:1154903151
Name:POWELL, CLIFTON DEMELLE JR
Entity type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:DEMELLE
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RANSON RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4818
Mailing Address - Country:US
Mailing Address - Phone:276-252-0091
Mailing Address - Fax:
Practice Address - Street 1:1111 RANSON RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4818
Practice Address - Country:US
Practice Address - Phone:276-252-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy