Provider Demographics
NPI:1558821900
Name:POWELL, ANETHIA SCHWANN
Entity Type:Individual
Prefix:MRS
First Name:ANETHIA
Middle Name:SCHWANN
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 1:4850 SUGARLOAF PKWY STE 209-345
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2859
Mailing Address - Country:US
Mailing Address - Phone:404-707-8180
Mailing Address - Fax:
Practice Address - Street 1:4850 SUGARLOAF PKWY STE 209-345
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2859
Practice Address - Country:US
Practice Address - Phone:404-707-8180
Practice Address - Fax:770-935-8116
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA440761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA440761OtherLIFE AND HEALTH