Provider Demographics
NPI:1497742969
Name:POWERS, REBECCA R (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:POWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E F ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3253
Mailing Address - Country:US
Mailing Address - Phone:423-547-9355
Mailing Address - Fax:423-702-4419
Practice Address - Street 1:117 E F ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3253
Practice Address - Country:US
Practice Address - Phone:423-547-9355
Practice Address - Fax:423-702-4419
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I370693OtherMEDICARE PTAN
TN1526375Medicaid
TN1526375Medicaid
TN3854896Medicare ID - Type Unspecified