Provider Demographics
NPI:1316112410
Name:POWELL, ALLEN R (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:R
Last Name:POWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:329 WESLEY ST STE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1721
Mailing Address - Country:US
Mailing Address - Phone:423-282-3150
Mailing Address - Fax:423-282-8533
Practice Address - Street 1:329 WESLEY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1721
Practice Address - Country:US
Practice Address - Phone:423-282-3150
Practice Address - Fax:423-282-8533
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical