Provider Demographics
NPI:1578156956
Name:POWELL, AMBER S
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:S
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DELDES
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8135 BALL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4412
Mailing Address - Country:US
Mailing Address - Phone:678-362-2274
Mailing Address - Fax:
Practice Address - Street 1:2458 JETT FERRY RD STE 230
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3060
Practice Address - Country:US
Practice Address - Phone:678-347-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002468225100000X
MI002468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist