Provider Demographics
NPI:1437345782
Name:POWELL, CASEY KIM (PA-C)
Entity Type:Individual
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First Name:CASEY
Middle Name:KIM
Last Name:POWELL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3179
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:
Practice Address - Street 1:1075 SATELLITE BLVD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4624
Practice Address - Country:US
Practice Address - Phone:678-957-0757
Practice Address - Fax:678-957-9597
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical