Provider Demographics
NPI:1063671188
Name:POWERS, STEPHANIE J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:POWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-856-0801
Mailing Address - Fax:336-856-2804
Practice Address - Street 1:1236 GUILFORD COLLEGE RD STE 117
Practice Address - Street 2:SUITE 216
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9875
Practice Address - Country:US
Practice Address - Phone:336-856-0801
Practice Address - Fax:336-856-2804
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2011-01307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918121Medicaid
NCNC1467AMedicare PIN