Provider Demographics
NPI:1114977477
Name:POWELL, NEIL GARRETT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:GARRETT
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 SE 1ST AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0478
Mailing Address - Country:US
Mailing Address - Phone:352-873-2880
Mailing Address - Fax:352-873-8751
Practice Address - Street 1:2801 SE 1ST AVE STE 302
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0478
Practice Address - Country:US
Practice Address - Phone:352-873-2880
Practice Address - Fax:352-873-8751
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35799174400000X
NDLT15664207T00000X
GUM-2045207T00000X
FLME50079207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376809Medicaid
3376809Medicare ID - Type Unspecified
TN3376809Medicaid