Provider Demographics
NPI:1619210119
Name:POWELL, BENJAMIN COLBY (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:COLBY
Last Name:POWELL
Suffix:
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 1:602 CYPRESS POINT CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9018
Mailing Address - Country:US
Mailing Address - Phone:864-293-5676
Mailing Address - Fax:
Practice Address - Street 1:630 13TH ST STE 250
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1017
Practice Address - Country:US
Practice Address - Phone:170-672-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37022208600000X
GA889512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery