Provider Demographics
NPI:1124214689
Name:POWELL, JAMES AMBUS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AMBUS
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:1444 TIFT AVE N
Mailing Address - Street 2:STE. B
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4618
Mailing Address - Country:US
Mailing Address - Phone:229-382-3210
Mailing Address - Fax:229-382-3213
Practice Address - Street 1:1444 TIFT AVE N
Practice Address - Street 2:STE. B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4618
Practice Address - Country:US
Practice Address - Phone:229-382-3210
Practice Address - Fax:229-382-3213
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2016-02-29
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Provider Licenses
StateLicense IDTaxonomies
GA7050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U77590Medicare UPIN
GA35ZCGRHMedicare Oscar/Certification