Provider Demographics
NPI:1518548957
Name:POWELL, OLITHA ELLENA
Entity Type:Individual
Prefix:
First Name:OLITHA
Middle Name:ELLENA
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-5737
Mailing Address - Country:US
Mailing Address - Phone:478-220-2919
Mailing Address - Fax:
Practice Address - Street 1:5322 PAGE ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-5737
Practice Address - Country:US
Practice Address - Phone:478-220-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health