Provider Demographics
NPI:1083854343
Name:POWELL, AVA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:AVA
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36175 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-3274
Mailing Address - Country:US
Mailing Address - Phone:586-464-0731
Mailing Address - Fax:586-464-1954
Practice Address - Street 1:36175 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3274
Practice Address - Country:US
Practice Address - Phone:586-464-0731
Practice Address - Fax:586-464-1954
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0705292085R0202X
MI51010173132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52609286002OtherBCBSGA
GAP01224298OtherRAILROAD MEDICARE
GA52609286001OtherBCBSGA
GA003137958AMedicaid
GA003137966AMedicaid
GA003137958AMedicaid