Provider Demographics
NPI:1730677626
Name:POWELL, NATASHA NICOLE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 MORELAND AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1500
Mailing Address - Country:US
Mailing Address - Phone:470-303-6938
Mailing Address - Fax:
Practice Address - Street 1:427 MORELAND AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1500
Practice Address - Country:US
Practice Address - Phone:404-228-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist