Provider Demographics
NPI:1932105699
Name:POWELL, MICHAEL FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANKLIN
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:FRANK
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-0840
Mailing Address - Country:US
Mailing Address - Phone:706-595-9080
Mailing Address - Fax:706-595-7090
Practice Address - Street 1:464 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-8123
Practice Address - Country:US
Practice Address - Phone:706-595-9080
Practice Address - Fax:706-595-7090
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000271323BMedicaid
GAGRP4181Medicare ID - Type Unspecified