Provider Demographics
NPI:1306104260
Name:POWELL AND ASSOCIATES DDS, PC
Entity type:Organization
Organization Name:POWELL AND ASSOCIATES DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROMETTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-319-9933
Mailing Address - Street 1:2800 SPRING ROAD
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3092
Mailing Address - Country:US
Mailing Address - Phone:770-319-9933
Mailing Address - Fax:
Practice Address - Street 1:2800 SPRING ROAD
Practice Address - Street 2:SUITE F-2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3092
Practice Address - Country:US
Practice Address - Phone:770-319-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000309174BMedicaid