Provider Demographics
NPI:1073713046
Name:POWELL, GEOFFREY I (PA-C)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:I
Last Name:POWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1222
Mailing Address - Country:US
Mailing Address - Phone:512-782-5001
Mailing Address - Fax:512-782-1949
Practice Address - Street 1:2200 W 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1222
Practice Address - Country:US
Practice Address - Phone:512-782-5001
Practice Address - Fax:512-782-1949
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant