Provider Demographics
NPI:1235237876
Name:POWELL, ROMETTA E (DDS)
Entity Type:Individual
Prefix:
First Name:ROMETTA
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SPRING RD SE
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3092
Mailing Address - Country:US
Mailing Address - Phone:770-319-9933
Mailing Address - Fax:770-801-8377
Practice Address - Street 1:2800 SPRING RD SE
Practice Address - Street 2:SUITE F-2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3092
Practice Address - Country:US
Practice Address - Phone:770-319-9933
Practice Address - Fax:770-801-8377
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00309174BMedicaid