Provider Demographics
NPI:1689618472
Name:POWELL, ANGELA HUFF (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HUFF
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANGELA
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:501 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WRENS
Mailing Address - State:GA
Mailing Address - Zip Code:30833-1185
Mailing Address - Country:US
Mailing Address - Phone:706-547-2559
Mailing Address - Fax:
Practice Address - Street 1:1023 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5879
Practice Address - Country:US
Practice Address - Phone:803-502-5515
Practice Address - Fax:803-502-5514
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR106617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00783967BMedicaid
GA00783967AMedicaid
GA00783967BMedicaid
GA50BBDDG01Medicare ID - Type Unspecified