Provider Demographics
NPI:1518921626
Name:POWELL, RONALD (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9317
Mailing Address - Country:US
Mailing Address - Phone:662-494-8500
Mailing Address - Fax:662-494-8488
Practice Address - Street 1:740 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9317
Practice Address - Country:US
Practice Address - Phone:662-494-8500
Practice Address - Fax:662-494-8488
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112991Medicaid
MS080001836Medicare ID - Type Unspecified
MS00112991Medicaid