Provider Demographics
NPI:1427288976
Name:POWELL, JONATHAN RICHARD (NMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:POWELL
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LEE ROAD 697
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-0444
Mailing Address - Country:US
Mailing Address - Phone:334-744-7167
Mailing Address - Fax:
Practice Address - Street 1:1995 PEPPERELL PKWY STE 6
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5460
Practice Address - Country:US
Practice Address - Phone:334-744-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1097175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath