Provider Demographics
NPI:1487627964
Name:POWELL, JOHN MANLEY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MANLEY
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 1:2301 N OCOEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3863
Mailing Address - Country:US
Mailing Address - Phone:423-339-1400
Mailing Address - Fax:423-339-9950
Practice Address - Street 1:2301 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3863
Practice Address - Country:US
Practice Address - Phone:423-339-1400
Practice Address - Fax:423-339-9950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD5262207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3814231Medicaid
TNB01115Medicare UPIN
TN3120933Medicare ID - Type Unspecified