Provider Demographics
NPI:1821072398
Name:POWELL, GEORGE EDMUND III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDMUND
Last Name:POWELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:EDMUND
Other - Last Name:POWELL
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3226 HAMPTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4226
Mailing Address - Country:US
Mailing Address - Phone:912-264-0760
Mailing Address - Fax:912-264-5798
Practice Address - Street 1:3226 HAMPTON AVE STE A
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4226
Practice Address - Country:US
Practice Address - Phone:912-264-0760
Practice Address - Fax:912-264-5798
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37046207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821072398OtherNPI
GA000360808GMedicaid
GA926016OtherPOCG
GA37046OtherMEDICAL LICENSE
GAREF000797672Medicaid