Provider Demographics
NPI:1033222682
Name:POWELL, ANDREW J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-0500
Mailing Address - Country:US
Mailing Address - Phone:501-605-1144
Mailing Address - Fax:501-605-1144
Practice Address - Street 1:25 HICKORY BEND DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-8183
Practice Address - Country:US
Practice Address - Phone:501-605-1144
Practice Address - Fax:501-605-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-68702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117390001Medicaid
AR50363Other'ALL OTHER INS COMPANIES'
ARC67814Medicare UPIN
AR117390001Medicaid