Provider Demographics
NPI:1043620719
Name:POWELL, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:4312 HOLIDAY INN EXPRESS WAY NW STE 203
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1469
Mailing Address - Country:US
Mailing Address - Phone:423-778-5661
Mailing Address - Fax:423-778-5664
Practice Address - Street 1:4312 HOLIDAY INN EXPRESS WAY NW STE 203
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-1469
Practice Address - Country:US
Practice Address - Phone:423-778-5661
Practice Address - Fax:423-778-5664
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126950207R00000X
TNMD0000056838207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine