Provider Demographics
NPI:1043201858
Name:POWELL, WILLIAM EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWIN
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 1:920 MATTHEW DR
Mailing Address - Street 2:STE A
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2567
Mailing Address - Country:US
Mailing Address - Phone:601-735-2401
Mailing Address - Fax:601-735-5205
Practice Address - Street 1:920 MATTHEW DR
Practice Address - Street 2:STE A
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2567
Practice Address - Country:US
Practice Address - Phone:601-735-2401
Practice Address - Fax:601-735-5205
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014356Medicaid
AL73007660POWOtherBLUE CROSS & BLUE SHIELD
MS0130143OtherUNITED HEALTHCARE
B30697Medicare UPIN