Provider Demographics
NPI:1427042407
Name:POWELL, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N CROSS ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1416
Mailing Address - Country:US
Mailing Address - Phone:606-387-6631
Mailing Address - Fax:606-387-8121
Practice Address - Street 1:106 N CROSS ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1416
Practice Address - Country:US
Practice Address - Phone:606-387-6631
Practice Address - Fax:606-387-8121
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65902355Medicaid
1280502Medicare ID - Type Unspecified
KY65902355Medicaid