Provider Demographics
NPI:1316138431
Name:POWELL, JOHN ANTHONY SR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:POWELL
Suffix:SR
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 1:4511 ROCKSIDE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2157
Mailing Address - Country:US
Mailing Address - Phone:216-901-0400
Mailing Address - Fax:
Practice Address - Street 1:697 E 91ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1232
Practice Address - Country:US
Practice Address - Phone:216-451-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA00860251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care