Provider Demographics
NPI:1528052248
Name:DR. JAMES A. POWELL, JR., D.C., P.C.
Entity type:Organization
Organization Name:DR. JAMES A. POWELL, JR., D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AMBUS
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:229-382-3210
Mailing Address - Street 1:1444 TIFT AVE N
Mailing Address - Street 2:STE B
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4618
Mailing Address - Country:US
Mailing Address - Phone:229-382-3210
Mailing Address - Fax:229-382-3213
Practice Address - Street 1:1444 TIFT AVE N
Practice Address - Street 2:STE B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4618
Practice Address - Country:US
Practice Address - Phone:229-382-3210
Practice Address - Fax:229-382-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4365Medicare PIN