Provider Demographics
NPI:1639146830
Name:POWELL, DEANNA HOLLAND (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:HOLLAND
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73709
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-3709
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:678-854-9235
Practice Address - Street 1:1900 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6357
Practice Address - Country:US
Practice Address - Phone:912-338-6511
Practice Address - Fax:912-338-6512
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA534720281CMedicaid
GAP00352166OtherRR MEDICARE INDIVIDUAL
GA534720281BMedicaid
GAP00352166OtherRR MEDICARE INDIVIDUAL
GA43BBCQXMedicare PIN
GA534720281BMedicaid