Provider Demographics
NPI:1700185642
Name:POWELL, JOEL ALONZO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ALONZO
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1304 13TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4359
Mailing Address - Country:US
Mailing Address - Phone:256-340-1251
Mailing Address - Fax:601-825-7280
Practice Address - Street 1:1304 13TH AVE SE
Practice Address - Street 2:STE A
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4359
Practice Address - Country:US
Practice Address - Phone:256-340-1251
Practice Address - Fax:256-353-6723
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2013-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.10713208D00000X
MI4301041543208D00000X
CAC40967208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147303Medicaid
AL102I010767Medicare UPIN
ALC-74961Medicare UPIN