Provider Demographics
NPI:1518965177
Name:POWERS, GRAHAM H III (MD)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:H
Last Name:POWERS
Suffix:III
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 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-2240
Practice Address - Street 1:514 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1906
Practice Address - Country:US
Practice Address - Phone:434-447-6969
Practice Address - Fax:434-447-2240
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA290306OtherSOUTHERN HEALTH KB
VA005644356OtherVA PREMIER
VA092717OtherBCBS #
VA142856OtherBCBS #
VA005640512OtherVA PREMIER KB
VA080020914OtherRAILROAD MEDICARE
VA30106OtherOPTIMA KB
VA4392714OtherAETNA
VA010157889Medicaid
VA1265680OtherCIGNA
VA1518965177Medicaid
VA67072OtherOPTIMA SH
VAA0999OtherMEDCOST KB
VA21307OtherCARENET SH
VA226497OtherBCBS #
VA1518965177OtherNPI
VA005640512Medicaid
VA290914OtherSOUTHERN HEALTH SH
VA890529TOtherNC MEDICAID
VA005644356Medicaid
VA080140290OtherKB RAILROAD MEDICARE
VA21989OtherCARENET KB
VA41380OtherMEDCOST SH
VA4392714OtherAETNA
VA290914OtherSOUTHERN HEALTH SH
VA1265680OtherCIGNA
VA142856OtherBCBS #
VA005640512Medicaid
VA010157889Medicaid
VA1265680OtherCIGNA
VA290914OtherSOUTHERN HEALTH SH
VA010157889Medicaid
VA005640512Medicaid
VA00Y193C03Medicare PIN