Provider Demographics
NPI:1518942077
Name:POWELL, ERIC W (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5608
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:134 ANSLEY DR STE 700
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1641
Practice Address - Country:US
Practice Address - Phone:706-701-5001
Practice Address - Fax:706-701-5002
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA049081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000978744KMedicaid
GA000978744EMedicaid