Provider Demographics
NPI:1659305928
Name:POWELL, EDDIE NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:NELSON
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28382-6610
Mailing Address - Country:US
Mailing Address - Phone:910-525-4062
Mailing Address - Fax:910-525-5164
Practice Address - Street 1:300 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2527
Practice Address - Country:US
Practice Address - Phone:910-904-0648
Practice Address - Fax:910-875-9658
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23962207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8968710Medicaid
NC0230YOtherBLUECROSS/BLUESHIELD PROV
NC0230YOtherBLUECROSS/BLUESHIELD PROV
NCC81166Medicare UPIN
NC8968710Medicaid