Provider Demographics
NPI:1184677395
Name:POWELL, DEBRA D (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:POWELL
Suffix:
Gender:F
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 1:1072 XRAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-671-1094
Mailing Address - Fax:704-671-1095
Practice Address - Street 1:7476 WATERSIDE LOOP RD. STE 600
Practice Address - Street 2:PIEDMONT PLASTIC SURGERY AND DERMATOLOGY
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-601-4381
Practice Address - Fax:704-822-5997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC2219A344Medicare PIN
NCS62995Medicare UPIN
NC2747727DMedicare PIN
NCNC2219AMedicare PIN